Routine inspection·February 7, 2022

Licensing Program Analyst(s) Mary Flores conducted an unannounced annual visit at the facility with focus on the infection control domain, food and medication review. LPA Flores met with Evelyn Mercado caregiver and explained the reason for the visit. Ralph Estanislao administrator arrived 40 minutes later. The facility is licensed to serve 5 non-ambulatory and 1 bedridden residents over the age of 60.The facility has 5 bedrooms, 3 bathrooms, a living room, a dining room, an activity room, a kitchen and an attached garage. The outdoor facility has a front yard, a back patio. LPA Flores conducted a tour of the facility with Evelyn Mercado caregiver at 9:15am and observed the following: Living room has a covered fire place, residents are sitting in TV area with social distancing. Kitchen was observed and chemical cabinet under sink and sharp drawer have locks, however were not locked at the time of the visit. Medication cabinet was located to the right above the stove and locked. LPA Flores reviewed food supplies and facility has a couple of meats, rice, dressings, and sauces, some cans of vegetables, tuna, vienna sausage, and fruits as emergency food supplies which is not within the required 2 days of perishables, and 7 days of non-perishable food supplies. Administrator send staff grocery shopping, per staff grocery shopping is on Mondays. LPA observed All bedrooms have the required furniture, lighting, and bedding in each bedroom. LPA tested water temperature in bathroom #1 at 121.6 degrees F, bathroom #2 at 121.3 degrees F, bathroom #3(B3) at 128.0 degrees F, which is not within the required 105 - 120 degrees F. LPA Flores observed. LPA Flores observed PRN medication in Bedroom #4 (R4) for resident currently under hospice and actively providing. LPA Flores reviewed medication for resident #1(R1) and #2(R2). Smoke detectors were tested and in working condition, carbon monoxide detector was observed in the TV area. LPA observed screening of visitors, staff, and residents including questionnaire. Posters were throughout the facility. Staff were observed wearing protective (PPE) were. At least 30 days worth of PPE supplies. Cleaning (CONTINUED ON LIC 809C) and disinfecting surfaces takes place twice a day per administrator. Staff have not been Fit test for N95, administrator is scheduling appointment for testing. Administrator Certificate was observed for Ralph Estanilao #60531027740 expiration date: 3/17/23. Deficiencies were noted on LIC 809D, technical violation, and technical advisory given Per Title 22 Regulations, Division 6 Chapter 8. Exit interview was conducted with Ralph Estanilao administrator and a copy of this report, LIC 809D, Technical Violation, and Technical Advisory were provided.