Routine inspection·May 28, 2021

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting an Annual Inspection. LPA met with Staff Member (Staff) Evangeline Bulaon and discussed the purpose of the inspection. Administrator (AD) Daniel Rescia was not present during the inspection. During the inspection, LPA and Staff conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: LPA and Staff observed there were 2 staff present, wearing PPE. LPA observed 4 residents were present. LPA confirmed all residents were doing well. LPA inspected common areas, resident rooms, garage, and kitchen, and observed they were clean and organized. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA observed hallways and walkways were free of obstruction. During the inspection, LPA and Staff observed the attached garage was not locked or lockable and contained toxins accessible to residents, including laundry detergent, automotive chemicals, and cleaning supplies. In the kitchen, LPA and Staff observed knives and toxins, including cleaning supplies, locked under the sink, but the key to the lock was accessible to residents on the sink countertop. In the backyard, LPA and Staff observed tools and toxins, including laundry detergent and cleaning supplies, available to residents on an open shelf behind a gate that was not locked or lockable. During the inspection, Staff reversed the lock on the garage door which allowed the garage door to be locked, removed and concealed the lock for the cabinet under the sink, and relocated the tools and toxins in the backyard to the locked garage and a locked storage cabinet in the back yard. ( Page 1 ) 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, staffing, infection control/lead/training, PPE, staffing and staffing shortages, communication and emergency plan, and dementia. LPA provided technical assistance regarding screening, surveillance testing, visitation, resident outings, COVID-19 signs, and N95 fit testing. LPA requested and reviewed resident roster, staff roster, staff files, emergency plan, and COVID-19 mitigation plan. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative. ( Page 2 )