Routine inspection·February 15, 2022

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting an Annual Inspection. LPA met with Administrator (AD) Marifel Antonette V. Ivers and discussed the purpose of the inspection. During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, garage, and kitchen and observed the following: LPA and AD observed there were 2 staff present. 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 AD observed the following: a resident residing in the south west room, designated on the floor map as a den/staff room, that commonly acts as the hallway/passageway to the backyard. AD stated that the resident had previously resided in one of the facility’s resident rooms, but had requested to live in the den/staff room recently. During the inspection, AD began the process of moving the resident back to their proper room, including by moving the resident’s clothes and personal items and LPA confirmed. Proof of the completion of the relocation will be sent to LPA by plan of correction due date. 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 N95 fit testing and storage. LPA requested and reviewed resident roster, staff roster, staff files, resident files, emergency plan, and COVID-19 mitigation plan. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.