Routine inspection·November 18, 2022

Licensing Program Analyst (LPA) V. Maldonado conducted an annual required visit. LPA met with caregiver Jonathan Diel and explained the purpose for the visit. Caregiver Tita Bartolata called Administrator Teresita Maralit to notify her of the visit. LPA used the Infection Control Tool to evaluate the facility. LPA inspected the physical plant with caregiver Tita, reviewed COVID-19 procedures, residents' medications, resident and staff files, and observed the food supply. Facility has submitted a mitigation plan and the plan was approved. The facility consists of (5) bedrooms, of which (1) is for live-in staff, (3) bathrooms of which (1) is for live-in staff, a living room, kitchen, dining room, TV room, shaded patio in the backyard and a detached garage. All resident bedrooms were toured and observed to have a smoke detector, the required furniture, linens, and sufficient closet and storage space. All bathrooms were observed to have a toilet, shower, and wash basin. The staff bathroom has a Jack & Jill hand wash sink and the sink to the right side was observed to be broken and inoperable with a bag covering it. Staff stated her boss is aware of it. The resident bathrooms were observed to have the required non-skid mats and grab bars. The hot water was tested and measured at 116*F in the staff bathroom and 131.5*F in the resident bathroom. The second resident bathroom did not have any running hot water at the hand wash sink. The staff stated her boss turned off the hot water to keep residents from burning themselves. The hot water requirement is currently not being met. The kitchen was toured and all appliances were operating properly. There was a sufficient amount of perishable and non-perishable food in the kitchen refrigerator, the kitchen pantry, and the refrigerator in the garage. LPA observed the vent in the dining area to be full of dust. The cabinets underneath the kitchen sink are broken and appears to be leaking. A tub of water was observed under the sink with some pads laid on the floor to absorb the water. All sharps were observed to be stored in a drawer next to the kitchen sink, however the lock on the drawer is broken, making the sharps easily accessible. LPA observed a cabinet near the entrance of the laundry room to the right, that stored cleaning supplies/toxins and laundry supplies (Report Continued on LIC809-C...) The cabinet did not have a lock and was accessible. Staff stated there should be a lock there, but the lock hinge is bent and does not close properly. The First Aid Kit was inspected and LPA discovered it was missing scissors, a thermometer, and bandages/roll bandages. A First Aid Manual was also missing. Staff stated she was unaware a manual was required- has never been asked for one before. The garage is used for storage and parking. LPA observed several cameras in the facility, located in the hallway and common areas only. The smoke/carbon monoxide detectors were tested and observed to be operational. Several fire extinguishers were observed throughout the facility with recent inspections and were fully charged. LPA reviewed all 4 resident files. Resident #1 (R1) is only has an admissions agreement on file and missing all other required documents. R2 and R4 are dementia care residents and do not have an updated medical assessment and reappraisal as required annually, for persons with dementia. During staff file review, it was discovered that caregiver Jonathan did not have a personnel file in the facility to review, but staff has fingerprint clearance and was associated to the facility. Caregiver Tita did not have current CPR/First Aid certification (exp 06/201), and did not have proof of required annual training certification on file. LPA reviewed 4 residents' medications. Medications are documented properly and given as prescribed. At the time that LPA entered the facility, staff did not assess or take LPA's temperature until LPA asked them to. When caregiver Jonathan opened the door to greet LPA, caregiver was observed to not be wearing a face mask, as required for COVID-19 procedures. Caregiver Tita was wearing a face mask, however it was hanging below her chin- not used properly. LPA asked both staff to place masks on properly and maintain them on during work hours, as required by COVID-19 procedures.Visitors were also observed to come in the facility without being properly screened and were not wearing face masks as required. LPA observed a 30-day supplies of Personal Protective Equipment (PPE) available and the required COVID-19 signgage posted throughout the facility to promote hand washing, cough/sneeze etiquette, and social distancing. LPA observed cloth hand towels at all hand wash stations and advised staff to remove them, as only paper towels should be used, per COVID-19 procedures. Per California Code of Regulations, Title 22, the deficiencies observed are documented on the attached LIC809-D. Technical Advisories were also issued regarding COVID-19 practices. An exit interview was conducted and a copy of the report, technical advisories, and appeal rights were provided to caregivers.