Routine inspection·September 21, 2022

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Caregiver Luzviminda Estrella and explained the reason for the visit. At 9:45 AM, LPA toured the facility with Caregivers Luzviminda and Epi Estrella. Facility has 6 residents present during today's visit with 1 on hospice. Facility does not have covid precaution signage outside the facility. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the entrance of the facility. Facility utilizes a visitor sign in sheet and documents temperatures. Facility has covid precaution postings inside facility. LPA observed residents relaxing in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. At 9:55 AM, LPA observed two out of five smoke detectors tested are not working due to missing battery or battery put in incorrectly. Smoke detectors have been removed from the hallway outside bedrooms. All resident rooms had the required elements as well as restrooms stocked with soap/ sanitizer. LPA observed Resident 1 (R1) has two bed rails on the bed, one at the foot and one at the head of bed. At 10:00 AM, LPA observed unsecured cleaning supplies in a common bathroom (photos). First aid kit has all required items. At 10:03 AM, LPA observed unsecured cleaning supplies in an unlocked cupboard in the alcove off the kitchen as well as the restroom adjacent to alcove (photos). LPA toured the outside grounds and observed multiple shaded outside visitation areas. Exit gates are unlocked and self latching. LPA observed the water in backyard pond is dark and murky. LPA toured the kitchen and observed ample food supply. Facility does not have emergency food and water. Residents participate in activities such as music, games, and exercise. Facility has ample supply of PPE and cleaning supplies. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. LPA reviewed select resident files during the visit and all files have updated emergency information. All residents and staff are vaccinated for Covid-19. During the visit, it was revealed that Resident 2 had tested positive for Covid-19 on approximately September 14, 2022 and was not reported to the department. LPA consulted with Caregiver regarding the importance of staff wearing masks at all times per department requirements. CONTINUED ON LIC 809C DATED 09/21/2022. Based on the observations made during today's visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided as well as appeal rights.