Routine inspection·November 4, 2022

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit to the facility for the purpose of conducting the required annual inspection using the Infection Control Evaluation Tool. LPA Maldonado met with staff Robby Sawada and explained the purpose for the visit. LPA observed the physical plant with staff, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. Facility has submitted a mitigation plan and the plan has been approved. Licensee Judy Ragano arrived shortly after and assisted with the visit. The facility is a home located in a residential area and is licensed to serve 6 residents, ages 60 and over. The license is approved for (5) non-ambulatory residents, (1) bedridden resident, and a hospice waiver approved for (6) residents and approved dementia care plan. The The home consists of (4) resident bedrooms, (2) bathrooms, kitchen, dining room, living room, visitor/office room, laundry room, a shaded patio in the backyard, and an attached garage. (2) resident bedrooms are shared, (1) is currently vacant, and (1) is private. LPA observed all resident bedrooms to have the required furniture, linens, and closets with additional storage space. All entrances/exits were observed to have operating auditory devices, during the visit. All walkways and pathways were observed to be free of obstructions and hazards. The food supplies in the facility was observed to be a variety of nutritious foods. The required 2-day of perishables and 7-day non-perishables foods was observed in the kitchen and garage refrigerators, as well as the kitchen pantry. All cleaning supplies/toxins were observed to be locked and inaccessible in a cabinet under the kitchen sink and all sharps were locked and inaccessible in a drawer in the kitchen next to the sink. A fire extinguisher was observed in the laundry room to have a recent inspection and be fully charged. LPA observed the bathrooms in the home to have a toilet, shower, and wash basin- all in good repair and operational. The water temperature was tested and measured at 113.5*F in bathroom#1 and 116.8*F in bathroom#2. (Report Continued on LIC809-C...) Smoke/carbon monoxide detectors were observed throughout the facility. They were interconnected and operational upon testing. The First Aid Kit was observed to have the required items and First Aid Manual. LPA did not observe COVID-19 signange posted throughout the facility to promote hand washing, mask wearing, cough/sneeze etiquette, and social distancing. A sufficient 30-day supply of Personal Protective Equipment (PPE) was observed in the garage and throughout the facility, accessible to residents in care. There is a central entry point designated for temperature/symptom screening. All hand washing stations were observed to have sufficient soap and paper towels. LPA reviewed 5 resident files. Files were complete and included appraisals, physician's reports, medical consent. LPA also reviewed 2 staff files to confirm health screenings, fingerprint clearances and training. LPA reviewed 5 residents' medications. Medications are documented properly and given as prescribed. There was a technical advisory given to the facility for failure to have the COVID-19 signage posted throughout the facility. This is a requirement for COVID-19 procedures. Per California Code of Regulations and Health and Safety Codes, no deficiencies were cited during today's visit. An exit interview was conducted with licensee Judy Ragano and a copy of the report and Technical Advisory was provided.