Routine inspection·April 29, 2022

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year inspection, with an emphasis on Infection Control due to the COVID-19 pandemic. LPA Martinez met and was granted entry into the facility by Staff Sandy Lim and Staff Wilma Lee. Staff Lee confirmed there are currently no cases or exposures of COVID-19 within the facility. LPA was screened upon entry into the facility. Facility Manager Rudy Ignacio arrived shortly after. LPA observed the required Department postings on COVID-19 precautions at entrance of facility and/or throughout the facility. There was a sign-in procedure in place and hand sanitizer for use. LPA observed staff were wearing face masks. The facility has an approved Mitigation Plan on file with CCLD. Five residents were present of which 3 are receiving Hospice care. LPA conducted a tour of the facility and made the following observations: LPA toured resident rooms, all rooms were within regulations. Restrooms observed contained hand washing soap, toilet paper and paper towels. The proper hand washing signs were up except in one bathroom. Facility has operating smoke and carbon monoxide detectors. Facility's Fire Extinguisher was charged. LPA observed a copy of Administrators Certificate which expired on 04/28/2023. 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 and documents. Facility has required Emergency Disaster Plan posted. Staff files were not available and staff are not associated to the facility. Four resident files were reviewed. LPA observed over-the-counter medication and a pre-poured pill box in unlocked cabinet in dining room, medication was also observed in 2 of 3 unlocked cabinets in hallway; only one cabinet was locked of the 3. Two bottles of medication were observed in the main refrigerator. Facility has 30 days supply of medications for the residents. One resident has 2 half bed rails on one side of the bed essentially creating a full bed rail. Per Facility Manager Ignacio resident is not receiving hospice services. Based on observations made during today’s inspection, the following deficiencies will be cited per Title 22, Division 6, of the California Code of Regulations. LPA reviewed report Facility Manager and copy will be emailed.