Routine inspection·June 15, 2022

Licensing Program Analyst (LPA) Nune Margaryan conducted an annual required visit. LPA met with 2 staff Staff 1 (S1) and Staff 2 (S2) . S1 was determined to not have a criminal record clearance. Shortly after Administrator Linda Fan arrived. The reason for the visit was explained. LPA used the infection control tool to evaluate the facility. LPA observed the physical plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed staff files. The facility cares for elderly residents and is allowed to have 10 hospice residents. There are currently 3 residents on hospice. LPA and Administrator toured the facility which included a random sample of resident rooms along with the kitchen, dining room, linen room, upstairs and downstairs lobbies, laundry room and medication room. The backyard patio area is well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the patio area. Passageways and exits are free of obstruction. The common areas are clean and have the required furniture. There is a screening station at the entrance of the facility which has PPEs and a thermometer to screen visitors. Staff document resident temperatures daily and require visitors to sign in. Facility currently has at least a 30-day supply of PPEs. The resident bathrooms have the required grabs bars and non-skid mat. The water temperature was tested in a random selection of resident bathrooms. Hot water temperature measured at 122.2 degree F in bathroom #201 and in share bathroom for the rooms #202 and # 203. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen and the linen is in good condition. Continue 809C. Smoke detectors were observed throughout the facility and were tested and operable during the visit. There is several carbon monoxide detectors throughout the hallways of the facility. There are several fire extinguisher located throughout the facility. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in the kitchen and are inaccessible to residents. Cleaning supplies and toxins were observed in the laundry room unlocked and accessible to residents. LPA reviewed 3 resident records to confirm emergency contact is updated, physician's reports are on file, and admission agreements are complete. Two staff records were reviewed to confirm health screenings, training and fingerprint clearances. LPA reviewed 3 residents' medications. Medications are documented properly and given as prescribed. First Aid kit was fully stocked with current manual. Per California Code of Regulations, Title 22, the deficiencies observed are documented on the attached 809D. Exit interview held. A copy of the report and appeal rights were provided to Administrator.