Routine inspection·August 1, 2022

On 08/01/2022 at 11:00am, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection centered on Infection Control measures. LPA arrived at facility, was greeted and granted entry by Robert Christian Aquina, caregiver after explaining the purpose of the visit. Administrator Miguelito Fajardo was also present to assist with the visit. At approximately 11:10am, LPA accompanied by Administrator toured the physical plant of the facility. LPA observed a check-in station where visitor temperatures are being documented. There are currently four (4) residents in care, one (1) of which is receiving hospice care. Residents are observed relaxing in the common areas or in their bedroom and appear clean and well taken care of. The five (5) bedrooms include all necessary components. The resident on hospice is observed to have full bed rails while another resident's bed is equipped with half rails for postural support. No written order for the support is present in the resident's file. LPA issues a Technical Advisory requiring the licensee to obtain the written order in question. Bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected. Sharp instruments are stored in a kitchen drawer, however the magnetic lock is observed to be non-functional. LPA observed a sufficient supply of food and water. A 30-day supply of medication is centrally stored and locked in a cupboard. Cleaning supplies are located in the locked laundry room. During the visit however, the door leading to the laundry room was observed to be unlocked, as was the cabinet where cleaning chemicals are stored. LPA observed the facility has COVID-19 Precautions posters and all required department postings as well as hand-washing signs in the bathrooms. Facility has an approved LIC808 Mitigation Plan on file. LPA provides consultation with licensee on the requirement to submit an updated Infection Control Plan to the Department. Facility has an adequate supply of PPE. Fire extinguishers are observed to be operational and charged. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Staff present is adequately associated in Guardian. LPA toured the outside of the facility and observed it to be free of obstructions. The perimeter gate is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises. Based on the observations made during today’s visit, one (1) type B deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report along with appeal rights was provided and left at facility.