Routine inspection·January 27, 2022

On 01/27/2022 at 9:51 am, Licensing Program Analyst (LPA) Troy Agard and Licensing Program Manager (LPM) Angela Kendrick conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. Upon arrival at the facility, a risk assessment was conducted by LPM Janae Hammond via telephone. Based on the assessment, the facility is clear of Covid-19 infection. LPA verified that the facility has an approved mitigation plan report. The facility is licensed for six (6) non-ambulatory residents, of which one (1) can be bedridden. Facility is approved for three (3) hospice. Currently, there are five (5) residents present during today’s visit. LPA met with Caregiver, Lanny Ttie and both toured the inside and outside grounds of the facility. LPA and LPM were properly screened for Covid-19 symptoms and temperature was checked. During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station near the facility front entrance. All staff was observed with a face covering. LPA observed required postings throughout the facility. All rooms were inspected. All rooms are shared. Bed linen were sufficient in amount, but mattresses needed bed covers, adequate lighting was provided, storage for resident personal belongings was observed. Furniture in the living room observed to be in good condition. There are no security bars or weapons on the premises. The client bathroom was checked, toilets and water faucets worked properly. The water temperature measured at 119 F. A comfortable temperature was maintained in the facility. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Cleaning supplies were observed unlocked. Centrally stored medications were observed stored in their originally received containers and observed locked and inaccessible to residents in care. One fire extinguisher was observed towards front entrance. Cont on 9099C Outside grounds were toured, no bodies of water observed. Walkways around the home were not clear of hazards. Common areas were observed cluttered; front doorway was free of obstruction. During a review of records, LPA observed the facility does not have an Administrator with a valid certification which is not in compliance with PIN 21-24CCLD. The following deficiencies were cited: 1) Personnel Records 87412 2) Resident Records 87506 3) Administrator - Qualifications and Duties 87405 4) Admission Agreements 87507 5) Personal Rights 87468.1 6) Maintenance and Operations 87303 7) Personnel Requirements – General 87411 Deficiencies cited under California Code of Regulations Title 22, Division 6, Chapters 1 and 6, see LIC 809D An exit interview was conducted, and a copy of this report was provided to Licensee/Administrator.