Routine inspection·February 16, 2023

At approximately 9:20AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year visit, and met with Staff Member, Ver Gonzalodo. Administrator, Laarni Lockerbie, arrived later during visit at approximately 10:00AM. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival at the facility, LPA had their temperature checked and logged. LPA answered a standard COVID-symptom questionnaire. LPA conducted a walk-through of the facility and observed the following: COVID-19 signs were observed at the entry way and throughout the facility. All staff present were observed to be wearing a mask. The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has a cleaning and disinfecting schedule that occurs twice per day. Facility has at least a 30-day supply of Personal Protective Equipment (PPE) and medication for Residents. Staff and Residents are screened daily for COVID-19 symptoms and it is logged into facility binders. LPA and Administrator discussed the following: Covid and Influenza A Protocols Staffing Resources and Staff Training Incident/Death Reports and Reporting Requirements Annual Inspection Expectations Facility has a plan in place if a staffing shortage were to occur. Facility has submitted their Mitigation/Infection Control Plan to Community Care Licensing (CCL). Continued on LIC809C Continued from LIC809 Fire extinguishers were last serviced August 2022. The last facility fire and evacuation drill was conducted in December 2022. Smoke Detectors and Carbon Monoxide alarms were tested and operational. LPA requested the following documents to update facility file: Facility Documents Administrative Organization (LIC 309) Affidavit regarding Client/Resident Cash Resources (LIC 400) Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610D) Updated Personnel Report (LIC 500) Current Administrator Certificate Surety Bond (LIC 402) Liability Insurance Updated Register of Clients/Residents (LIC 9020) Facility Documents to be submitted to CCL by due date of Monday, March 16th, 2023. *Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.