Routine inspection·September 6, 2022

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required annual inspection focusing primarily on the Infection Control. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty who checked temperature prior to entering facility. During the visit, 2 staff were on duty, who contacted facility administrator (AD) Rizalina Reyes about visit. AD Reyes was unable to be present during time of visit, but provided consent for Lead Caregiver (CG) Emelyn Read to conduct tour, and receive and sign report. As of 9/6/22, there are 0 active COVID-19 cases in the facility as verified. LPA De Perio observed the COVID-19 precautionary signs posted throughout the facility. The PUB475 "See Something, Say Something" poster was also observed entrance. LPA observed the Administrator's Certificate for Rizalina Reyes, which expires on 6/30/23. LPA De Perio toured the interior and exterior portions of the facility with LG Read. The facility is a two level structure and is licensed for 6 non-ambulatory, 0 bedridden and 4 hospice. LPA De Perio toured the second level of facility and observed no residents residing on the second floor and verified that the second level is not for resident use. For this visit, there are a total of 4 residents in care, 2 on hospice, 0 bedridden. All bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. The restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 109.8 degrees Fahrenheit and hand washing signs were also posted in each restroom. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Fire extinguisher was charged, mounted and located in the kitchen. LPA De Perio observed the emergency disaster and evacuation plan, which is posted at the entrance of the facility. Facility had back-up emergency food and water supply, located in the garage. LPA De Perio observed that First Aid Kit had all the required components. The facility had an adequate supply of PPE that was located in the garage. For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. There are 2 gates in the backyard, which was self-closing and self-latching. A swimming pool was observed to be in the backyard, of which there is a locked gate surrounding it. LPA De Perio verified the Coronavirus 2019 (COVID 19) mitigation plan of the facility with AD Reyes. LPA De Perio discussed Assembly Bill 665 requires that a licensee of any adult or senior care residential facility that has internet service provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use. LPA De Perio discussed with AD Reyes to review, and subscribe for emails regarding the Provider Information Notices (PINs) as well as to attend the CCLD Informational Calls to ensure that facility and staff are up to date. The PINs can be accessed at: www.ccld.ca.gov . For today's visit deficiencies were issued per Title 22 Division 6 of the California Code of Regulations and Appeal Rights were printed and provided. LPA De Perio advised AD Reyes to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for any inquiries and to specify attention to the assigned LPA. LPA De Perio conducted an exit interview with AD Reyes via telephone and CG Read and a copy of this report was provided to the facility.