Routine inspection·June 17, 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 Administrator (AD) Maria Parungao 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, kitchen, and garage and observed the following: LPA and AD observed there were 2 staff present, wearing PPE. LPA observed 5 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: in the kitchen, knives were accessible to residents in non-lockable cabinet and under-bench storage; in the laundry room, prescription medications, cleaning supplies (including laundry detergent), and scissors were accessible to residents in lockable but unlocked cabinets (with the keys hanging in immediate proximity) and non-lockable cabinets; in the unlocked garage, cleaning supplies (including bleach) were accessible to residents. During the inspection, AD and facility staff properly secured all of these items and LPA confirmed. 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, PPE, changes in condition, physical plant, 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 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.