Routine inspection·March 14, 2022

License Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct a Required – 1 year Infection Control Inspection of the facility. LPA was welcomed by front desk who contacted Administrator, Terrance Tumbale for the visit. There is a total of 21 assisted living residents and 240 independent living residents and 35 in the skilled nursing facility. One resident in Assisted Living is on Hospice. The facility is an eleven story CCRC with independent living and assisted living setting licensed by Community Care Licensing on all floors. The assisted living setting is on the second floor. The facility also has a skilled nursing setting that is not licensed by Community Care Licensing. LPA toured the assisted living part of the facility on March 14, 2022 at 9:30 AM with Administrator, Terrance Tumbale; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on March 7, 2022. There are emergency lights in many of the fixtures in the common areas of the facility that come on should a power outage occurs. Hot water temperature measured between 115.3 degrees F and 125.6 degrees F falling out of Title 22 acceptable regulation of 105 to 120 degrees F in 5 of 8 resident’s bathrooms while touring facility on 3/14/2022 at 09:30 AM. (see LIC 809-D). Administrator contacted facility service director Stewart Dalie to adjust water temperature while LPA was touring facility. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations at the time of the visit. LPA toured the kitchen area with Executive Director and learned that there are provisions made for individuals/residents with special dietary needs. Report continued on LIC 809C Food is available for residents any time of the day. There is a daily activity schedule for residents. Toxins are stored in a locked housekeeping room. There is supply of cleaners, hygiene products and paper products available for residents. Infection Controle: Facility has submitted a mitigation program plan that has been approved, on 4/19/2021. All staff and visitors check in and log temperatures and either have proof of vaccination on file or show proof of a negative COVID test within the last 72 hours. Posters have been placed at facility. Facility has PPE supply stored in basement. Staff had all PPE training required as well have been N95 Fit Tested. All but 1 staff has received their COVID booster shot and the one has an exemption letter on file and tests weekly. Facility conducted last disaster drill in 12/2021. LPA reviewed Licensing Information System (LIS) with Administrator who stated that email needs to be updated. LPA advised facility to contact Local County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. LPA was presented with proof of CPR & 1 st Aid certification for staff. LPA viewed Administrator NHA Certificate for Terrance Tumbale #6051324740 Expiration 02/25/2023 The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. Appeal of Rights Given LPA Hansen is requesting Licensee to update and submit the following documents by 4/14/2022 to RPRO: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 610E-S Supplemental Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Proof of Liability Insurance