Routine inspection·September 12, 2022

On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted, COVID-19 screened and granted entry into the facility by Front desk Receptionist. LPA Quiroz met with Itzayana Barba, Health and Wellness Director (HWD) and explained the nature of the visit. This facility is licensed to provide services to residents age range 60 and over. Approved for 95 Non-Ambulatory residents, of which 12 may be bedridden and has an approved hospice waiver for 20 residents. The facility is providing services to (4) four Hospice residents at this time. (HWD) Barba indicated Juan Jorge Poemape Diaz, Operations Manager (OM) is currently not present at the facility and indicating "Company is currently hiring for (ED) position as (OM) Poemape-Diaz is resuming a new position with the company. However Juan Jorge Poemape-Diaz and Phat Nguyen are covering the Administrator duties." Administrator Juan Jorge Poemape-Diaz has an Administrator certificate with expiration date of 11/04/2023. On or about 9:58am LPA Quiroz along with (HWD) Barba toured the inside and outside of facility. All staff working at facility were observed to be wearing face masks upon arrival to facility. There are fifty-one (51) residents in care and there are no active COVID-19 cases. On or about 10:18am, LPA Quiroz along with Food Service Manager toured the kitchen area. During today's inspection visit, LPA Quiroz observed residents in their rooms resting, in activity room, in front area of facility smoking in designated facility smoking area and eating their lunch. On or about 10: 40am, while LPA Quiroz along with (HWD) Barba toured laundry area, LPA Quiroz observed bucket of opened laundry detergent without lid. (HWD) Barba removed laundry detergent from laundry area immediately. CONTINUED ON NEXT PAGE.... At 11:30am, LPA Quiroz provided consultation on CCR 87705(f)(2) with (HWD) Barba and Maintenance Director (MD) Ryan Mims. On or about 12:45pm, while LPA Quiroz along (MD) Mims conducted a facility inspection tour addressing Complaint control #:22-AS-20211119134410, LPA Quiroz observed a bag of Tide pods Laundry detergent on laundry basket on top of chair next to laundry area without staff supervision. This was verified with (MD) Ryan Mims. This poses a potential risk to residents in care. (See LIC 809-D). The residents appeared to be clean and well taken care of. LPA Quiroz observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer. LPA Quiroz inspected residents’ bedrooms with all required components. LPA Quiroz observed a check in station and resident/visitor log-in in the main entry of the facility. LPA Quiroz observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water supply as well as PPE supplies stored in storage room on second floor. LPA Quiroz toured the outside of the facility and observed seating area with table and chairs for resident’s enjoyment in court yard on first floor and second floor balcony. Facility has completed the LIC 808 Mitigation plan, which was approved by LPA Micah Martinez on 3/12/2021 and has submitted an Infection Control Plan. Based on the observation made during today’s visit, deficiency was noted today per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with (HWD) Itzayana Barba, and a copy of this report, LIC 809-D, and Appeal Rights were provided at exit.