Routine inspection·December 22, 2021

Licensing Program Analyst (LPA) K.. Hiratsuka and Talwinder Bains , arrived at the facility unannounced on 12/22/2021 to conduct an unannounced annual visit using the infection control tool visit. LPAs met with Facility Caregiver Courtney King, and explained the purpose of the visit. Prior to initiating the visit, LPAs completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms.. LPAs ensured hand hand sanitizer shortly after entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Caregiver. LPAs and Caregiver toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, and common restroom. LPAs and Caregiver completed the infection control domain and the facility was not in compliance with parts of the infection control domain. LPA Hiratsuka, spoke to Administrator Daisyree Tacandong, over the phone during visit. The following issues were found and discussed during the phone call with Administrator. Administrator stated she will get the below done. They are not cited. : -No required Covid 19 precaution posters were posted in the facility and front door. -the staff have not been fit tested for N95 respirators to ensure proper fit -no staff screening logs -no resident screening logs The following citation was issued and a civil penalty of $500.00 was issued immediately: -a lock that has not been approved by the fire department and Community Care Licensing Division is on the front door preventing residents from getting out. This lock is not part of the approved door lock for the door. This lock is positioned above the approved door lock. This is a fire hazard because it it not approved. It was explained there is a resident who wanders and it prevents the resident from leaving This is also a possible level of care issue because due to the resident conditions, the resident(s) may not be appropriate for this facility. Licensee shall address the issue. If Licensee wants to use the lock, then she shall submit to Community Care Licensing Division a waiver request for a locked perimeter and also shall submit for a fire clearance. Lock shall be removed as soon as possible and not used until removed. Deficiency is cited on 809-D, per Title 22 Regulations, Division 6. Civil penalties of $500.00 was issued immediately and shall accrue at $100.00 per day until Licensee informs Community Care Licensing Division the citation is corrected. Appeal rights were provided to Caregiver. Exit interview conducted and copy of report left at the facility.