Routine inspection·November 30, 2021

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year Annual inspection, with an emphasis on Infection Control due to the COVID-19 pandemic. LPA Martinez met and was granted entry by Staff Soledad Larcia. Staff Larcia confirmed there are currently no cases or exposures of COVID-19 within the facility. LPA observed the "No Visitors" Department posting on COVID-19 precautions at the front door and one posting on refrigerator. There is no sign-in procedure in place, only hand sanitizer for use. LPA observed that both staff were wearing face masks. The facility has an approved Mitigation Plan on file with CCLD. There were 6 residents present during this visit, 2 receiving Hospice Services. LPA conducted a tour of the facility and made observations pertaining to the facility's Infection Control measures. LPA toured all resident rooms, all rooms were within regulations. LPA noted medication in Resident 1 (R1) room. Restroom observed contained soap, toilet paper, but no paper towels, and no hand washing signs posted. Facility has operating smoke and carbon monoxide detectors. Facility has Fire Extinguishers which was last charged on 03/04/2021. The facility was equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Personal Protective Equipment (PPE) supply is available. The facility monitors the residents regularly for any COVID-19 symptoms/change of condition. Facility has required Emergency Disaster Plan posted, and a secured location for resident's medication and files. Facility has 30 days supply of medications for the residents. Residents emergency contact information and Physicians reports are current. LPA reviewed resident files. Based on the observations made during the visit, the following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report, along with Appeals Rights, Confidential Names (Lic811), LIC9102 TA) was discussed with the Administrator and copies will be emailed.