Routine inspection·August 25, 2022

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted by staff Lucille Nofies and granted entry into the facility. LPA Gutierrez discussed the purpose of the inspection. A single resident was eating at the dining table, LPA observed and took picture of medication on dining table that was left unattended. LPA asked the resident if the medication was theirs, resident stated “oh, no. I’ve already had mine”; a Deficiency was cited on today’s date. Administrator (AD) Maria Semcheshen arrived at 10:40 a.m. During the inspection LPA Gutierrez and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a single-story house with five bedrooms, and two bathrooms, with two bedrooms being occupied by staff. During the inspection LPA observed one staff and four residents in care. Residents were observed resting in their respective rooms and in the common area. A 2-day supply of perishable and a 7-day supply of non-perishable food was observed during today’s visit. Upon record review LPA noted emergency care requirements were met. LPA observed the facility does not have a 30-day supply of PPE on hand; a Technical Advisory was given on this date. Under the patio in the back of the house LPA observed storage bins stacked to the ceiling, different bags and boxes also stacked on top of one another, and a washer with tape on the front of the door and a piece of tubing inside. On the side of the home an empty television box, a toilet, a table with dust laying on its side, empty water bottles, a 5-gallon industrial bucket, and different pieces of cardboard were all observed; a Deficiency was cited on today’s date. LPA reviewed and confirmed facility policies and practices regarding resident screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, infection control training, PPE, staffing and staffing shortages. Based on the observations made during today’s inspection, two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.