Routine inspection·September 29, 2022

On 09/29/2022 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 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 Eric Goldstein was notified by phone and arrived shortly afterwards to assist with the visit. At approximately 3:45pm, LPA accompanied by administrator toured the physical plant of the facility. There are currently six (6) residents in care, two (2) of which are receiving hospice care. Residents are observed relaxing in the facility's common areas or in their respective bedrooms. All appear clean and well taken care of. The six individual 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. Physician orders for the residents whose beds are equipped with postural supports are kept in the residents files and presented to LPA when requested. Sharp instruments are kept in a locked drawer in the kitchen. Cleaning supplies are located in a cabinet under the sink with a magnetic lock as well as in the attached garage. The centrally stored medication is located in a locking metal cabinet in the formal dining area. However lock was non-functional when initially observed. LPA observed a sufficient supply of food and water present. An emergency supply of food is also stored in the attached garage. LPA observed the facility has COVID-19 Precautions posters and all required department postings along with hand washing signs. The fire extinguishers present are charged and have up-to-date maintenance shown on the attached tags. Sound alarms are present and functional on the facility's exit routes. Staff present is adequately cleared and associated in Guardian. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and administrator toured the outside of the facility and observed it to be free of obstructions. Outdoor furniture and a shaded area are present in the front yard for the enjoyment of residents and visitors. A shed in the backyard is used to store medical equipment, furniture and appliances. The perimeter gate on one side of the house is 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, a deficiency are 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.