Routine inspection·August 1, 2022

On 08/01/2022 at 3:00pm, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection. LPA arrived at facility, was greeted and granted entry by Belinda Rilengado, caregiver and Evelyn Deldio, caregiver after explaining the purpose of the visit. Administrator Rita Lee was called and notified of the visit but could not join in person. At approximately 3:10pm, LPA accompanied by caregivers toured the physical plant of the facility. LPA observed a check-in station at where visitor temperatures are being documented. There are currently four (4) residents in care, none of which are receiving hospice care. Residents are observed relaxing in their respective bedrooms and appear clean and well taken care of. The bedrooms include all necessary components. Bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected. Sharp instruments are stored in a locked kitchen drawer. LPA observed a sufficient supply of food and water. A 30-day supply of medication is centrally stored in a closet next to the kitchen. Cleaning supplies are located in the laundry room. During the visit, both the door leading to the laundry room and to the centrally stored medication were observed to be unlocked. LPA observed the facility has COVID-19 Precautions posters and all required department postings as well as hand-washing signs in the bathrooms. Facility has an adequate supply of PPE. CONTINUED ON FORM LIC809-C CONTINUED FROM LIC809 The two caregiver present are part of the reliever team rather than the permanent staff. Staff S1 is shown to be cleared and associated correctly to the facility, however caregiver S2 is cleared but has not been associated to the facility in Guardian. LPA toured the outside of the facility and observed it to be free of obstructions. The perimeter gates are self-latching but are being secured by carabiniers on the inside of the yard, slowing down the possibility of egress in an emergency. Upon LPA's request, staff member removed the carabiniers from the gates' latches. There is a fountain but no bodies of standing water are present on the premises. Based on the observations and file review conducted during today’s visit, two (2) type A and one (1) type B deficiencies are being cited and one (1) Technical Advisories are issued per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report along with appeal rights was provided and left at facility.