Routine inspection·December 1, 2022

On 12/1/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tools. LPA Montoya called Administrator Roneilio Garcia and conducted a risk assessment. Based on the assessment, the facility is clear of Covid-19 infection. LPA verified that the facility has an approved mitigation plan report. LPA met with House Manager Lisa Buencillo and Angela Tortona and they toured the inside and outside grounds of the facility. The facility is licensed for six (6) non- ambulatory, of which six (6) may be bedridden; approved hospice waiver for six (6) residents. LPA observed six (6) residents of which three (3) are hospice and two (2) direct caregivers during the visit. The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, three (3) bathrooms, one (1) living area, one (1) dining area, kitchen, covered outside patio and an attached two (2) car garage. During the tour, LPA did not observe bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. There are no security bars or weapons on the premises. Resident bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly, grab bars were secure, the shower was free of mold/mildew, and a non-skid mat was in place. The water temperature measured at 117.9 degrees Fahrenheit. A comfortable temperature was maintained in the facility. Smoke detectors and carbon monoxide are operational. LPA observed the facility was found to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food supplies. The facility conducted a Fire/Safety Drill on 9/24/2022. A working telephone remains available. Evaluation Report Continues on LIC 809C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for residents, staff and visitors, and sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved Mitigation Plan Report on file with CCLD. Technical Assistance and citations were issued. Deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted and appeal rights discussed. A copy of this report and appeal rights provided to House Manager Lisa Buencillo.