Routine inspection·August 31, 2021

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year Annual inspection, with an emphasis on Infection Control due to the COVID-19 pandemic. LPA Martinez met with Staff Rodolfo De Castro and Lucena Prietos. Staff De Castro confirmed there are currently no cases or exposures of COVID-19 within the facility. LPA was screened upon entry into the facility and asked to use a hand sanitizer/hand wash. Administrator Linda Bolivar was unavailable. LPA observed the required Department posting on COVID-19 precautions at entrance of facility. There is a sign-in procedure in place and hand sanitizer for use. LPA observed that all staff were wearing face masks. The facility has an approved Mitigation Plan on file with CCLD. There are 4 residents present during this visit. 5th resident is hospitalized. LPA conducted a tour of the facility and made observations pertaining to the facility's Infection Control measures. LPA toured all resident rooms, all rooms where within regulations. All restrooms observed contained soap, toilet paper and paper towels. Restrooms had proper hand washing signs posted. Facility has operating smoke and carbon monoxide detectors. Facility has Fire Extinguisher which was charged. LPA observed a copy of Administrators Certificate which expires 02/15/2023. The facility was equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Personal Protective Equipment (PPE) supply is available. The facility monitors the residents regularly for any COVID-19 symptoms/change of condition and documents. Facility has required Emergency Disaster Plan, and a secured location for resident's medication and files. Facility has 30 days supply of medications for the residents. Residents emergency contact information and Physicians reports are current. LPA noted room #1 on floor plan is Caregiver room. Currently this room is being used as a resident room. LPA spoke with Staff 1 who stated he sleeps in the living room on a fold up cot. LPA observed storage room next to kitchen on the floor plan was converted into a staff room; Staff 2 confirmed she sleeps in this room on a fold up cot. Based on observations made during today’s inspection, the following deficiency is being cited per Title 22, Division 6, of the California Code of Regulations. LPA reviewed this report with Staff De Castro. Report will be emailed to email on file .