Routine inspection·July 27, 2022

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced annual visit with focus on infection control domain, medication and food review. LPA met with Maria Sereno caregiver and explained the reason for the visit. LPA inquired caregiver about notifying administrator, caregiver indicated it was not necessary to notify administrator/licensee regarding visit. The facility is licensed to serve 5 non-ambulatory residents ages between 60 and over and a hospice waiver for 2 hospice residents. Facility is a one story single home in a residential area and consists of the following: 3 bedrooms, 3 resident bathrooms, 1 staff bathroom, garage, gated pool with pool house. Backyard has an area with tables/ umbrellas for shade. Facility has a living room, kitchen/dining room and front porch. Pool house is inaccessible to residents. LPA Flores conducted a tour of the facility with Maria Sereno Caregiver and observed the following: Screening area was recommended to be place by entry way rather than in the middle of the living room to prevent from visitors entering the facility prior screening process. Staff were observed without face covering. Living room has a cover fireplace, sufficient sitting area, and signs posted. Medication cabinet is located in the living room, PPE supplies were observed in a cabinet and is not sufficient for at least 30 days. Kitchen was observed and cabinets under the sink labeled knives and cleaning supplies were observed unlock during the visit. Facility has sufficient food supplies for at least 2 days worth of perishables and 7 days of non-perishables. Residents rooms were observed as follows: Room #3 (R3) has all required furniture and bedding, 3 out of 4 small light bulbs were not working and sufficient lighting is not provided. Room #1(R1) and Room #2(R2) have all required furniture, bedding, and sufficient lighting. Bathroom #1(B1) was observed and shower floor was observed damage and in disrepair, bathroom #2(B2) had bleach solution on top of the toilet and under the sink unlocked cabinet, water temperature was measured as follow: B1 at 133.5 degrees F., B2 tested at 133.2 degrees F., and Bathroom #3(B3) tested at 133.3 degrees F., which is not within the required 105-120 degrees F. (CONTINUED LIC 809C) Staff bathroom and resident bathrooms are missing proper hand wash signs. Smoke/Carbon Monoxide detectors were observed, tested, and in working condition. Fired extinguisher was observed last reviewed on 7/26/21. Backyard was observed and grass was over growth, boxes, and a gas tank were piled on the wall of the grass area, and large toys were hanging from the pool gate. Medication and files were review for 3 residents. Staff files were not reviewed ans staff stated staff files are not available at the facility. Deficiencies were noted on LIC 809D per Title 22 Regulations and Technical advisories will be given for infection control guidance. Exit interview was conducted with Maria Sereno caregiver and a copy of this report, LIC 809D, and appeal rights was provided.