Routine inspection·October 3, 2022

On 10/03/2022 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 mostly focusing on Infection Control procedures. LPA was greeted and granted entry by caregivers after undergoing the COVID-19 screening procedure and explaining the purpose of the visit. Administrator Jennifer Perez was notified by phone. Administrator couldn't assist with the visit as they had a previously scheduled appointment to attend. LPA agreed to go over the report with the administrator prior to having a facility representative sign it. At approximately 3:30pm, LPA accompanied by caregivers toured the physical plant of the facility. There are currently four (4) residents in care, one of which is receiving hospice care. Residents are observed relaxing in their respective bedrooms. All appear clean and well taken care of. The three (3) shared bedrooms include all necessary components of furnishing. Bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected. An ample supply of linen is observed. Sharp instruments are kept in a kitchen drawer equipped with a functioning magnetic lock. Cleaning supplies are located in a kitchen cabinet under the sink, also equipped with a functioning magnetic lock. Additional cleaning supplies and detergents are located in the attached garage, which is secured with a combination doorknob. The centrally stored medication is located in a locked closet near the dining room. LPA observed a sufficient supply of food and water present. The facility has COVID-19 Precautions posters and all required department postings along with hand washing signs. The fire extinguisher present is charged. The maintenance tag attached to it shows a maintenance date of November 2020, which means that the maintenance is out of date by almost two years at the time of the visit. Staff present is adequately cleared and associated in Guardian. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and caregiver toured the outside of the facility and observed it to be free of obstructions. Outdoor furniture and a shaded area are present in the backyard for the enjoyment of residents and visitors. The entrance gates on both sides of the house are self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises. Based on the observations made during today’s visit, one deficiency is being cited 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.