Routine inspection·July 13, 2022

Licensing Program Analyst (LPA) Vasallo conducted an annual required visit. LPA met with Staff #1 (S1) and explained the reason for the visit. Administrator, Margarita Stark was called and arrived a short time later. LPA used the infection control tool to evaluate the facility. LPA observed the physical plant, COVID-19 procedures, reviewed residents' medications and records, staff records and observed the food supply. The facility cares for elderly residents and is approved to care for 4 hospice residents. There are currently 2 residents on hospice. All resident bedrooms were toured. Bedrooms have the required bed, bedframe, linen, dresser, light, and closet space. Resident bathrooms were toured and the hot water was 116.4 degrees which is within the required 105 - 120 degrees. There were no toxic chemicals accessible to residents. The kitchen was inspected. There is sufficient perishable and non-perishable food. All the appliances are clean and are operating properly. There is a second refrigerator in the outside patio. The common areas include the living room and dining area. These areas are clean and have the required furniture. Facility currently has at least a 30-day supply of PPEs. There are cameras inside the facility in common areas only. There is a screening station with PPEs at the entrance of the facility. Staff document resident temperatures and symptoms daily. Resident files were reviewed. Resident #1 (R1) and Resident (R2) did not have a pre-admission appraisal on file. R1 also did not have an admission agreement on file. Staff files were reviewed to confirm health screenings, training and fingerprint clearances. S1 and Staff #2 (S2) did not have health screenings on file. All residents' medications were reviewed. Medications are documented properly and given as prescribed. Per California Code of Regulations, Title 22, the deficiencies observed during the visit are documented on the attached 809D. Exit interview held. A copy of the report and appeal rights were provided.