Routine inspection·June 23, 2022

Licensing Program Analyst (LPA) Jessica Cho conducted an unannounced required annual inspection focusing primarily on the Infection Control. At 11:28 am, LPA was greeted and granted entry by Caregiver Ramon Flores Somo after completing the Coronavirus 2019 (COVID-19) screening procedure, and LPA stated the purpose of the visit. As of today, there are no active COVID-19 cases in the facility. Facility screens and documents temperature for all visitors on a sign in sheet. LPA observed the required COVID-19 precautionary signs posted on the door of the main entrance and throughout the facility. The PUB475 See Something, Say Something poster was not observed in the facility. The Administrator's Certificate for Emmanuel Dizon expires on 9/15/2023. At 11:38 am, LPA toured the interior and exterior portions of the facility with the Admin. The facility is a single level structure and licensed for six non-ambulatory residents; and has a hospice waiver for five. Currently, there a total of five residents in the facility of which two are in hospice care. Facility appeared clean and sanitary in all areas observed. All bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, carbon monoxides, and auditory exit alarms tested operational. The restrooms were observed to be in good repair; and provided with grab bars and non-skid floor mats. Hot water measured at 112.2 degrees Fahrenheit in Restroom #1; 110.4 degrees Fahrenheit in Restroom #2; and 115.5 degrees Fahrenheit in Restroom #3. LPA observed hand washing signs, paper towels, and hand soaps in all three restrooms. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies, and sharp items were inaccessible to the residents in care. The fire extinguisher was charged and mounted in the kitchen/dining room. For the exterior portion, LPA observed patio furniture under a lattice, and the grounds were free of tripping hazards. The side gates were self-closing and self-latching. LPA reviewed the Emergency and Disaster Plan for Residential Care Facilities for the Elderly (LIC610E). Facility has a plan for COVID-19 testing residents and staff as well as a plan for isolation as needed. Facility had back-up water supply of (2) 10 gallons stored in the garage but did not have emergency food during the visit The First Aid Kit had all the required components except a first aid manual, and the facility had sufficient PPE and incontinence supplies also stored in the garage. LPA discussed Assembly Bill 665 that requires a licensee of any adult or senior care residential facility that has internet service to 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. Residents have access to a smart phone upon request. LPA consulted the following: Facility shall post the PUB475 See Something, Say Something Complaint Poster in the size of 20"x26," facility to purchase the current edition of the first aid manual, and to maintain sufficient supply of emergency food. LPA reviewed the approved COVID-19 mitigation plan of the facility. No deficiency cited in this review as per Title 22 Division 6 of the California Code of Regulations. Advisory Notes (LIC9102) were issued during the visit, and the licensee will follow-up with the corrections. An exit interview was conducted with Administrator Sherry Dizon, and a copy of this report was provided.