Routine inspection·October 13, 2022

Licensing Program Analysts (LPAs) Ryan Gardner and Victoria Chitigian made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPAs met with Caregiver Alexander Angulo and was granted entry to the facility. At the time of the visit there was one (1) staff, and five (5) residents present. LPAs toured the facility inside and out and went over COVID-19 best practices for infection control and prevention with Alexander Angulo. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining residents and properly caring for residents with COVID-19 positive results and/or exposures. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE. The entrance of the facility has a check in process for visitors that includes a temperature check and a symptom check. The residents have hand sanitizer available to them throughout the facility, and the bathrooms were stocked with hand soap and paper towels. The facility has postings throughout the facility for proper cough etiquette, proper hand washing procedure, and/or social distancing guidelines. LPAs requested to inspect the facility's Personal Protective Equipment (PPE) supply, which was located in the hallway cabinet. The facility has a full thirty (30) day supply of PPE items such as gloves, face shields, gowns, disinfectant, surgical masks, N95 masks, and hand sanitizer. All residents and staff are practicing all other COVID-19 precautions, which minimize the risk of them contracting COVID-19. During today’s visit, LPAs found that the resident’s medications were removed from their prescription bottles and stored in plastic containers which poses an immediate health, safety, or personal rights risk to persons in care. LPAs took pictures of the resident's medications in the plastic containers. LPAs found that the bathroom near the hallway closet had a toilet without a toilet tank cover. The facility is using a piece of wet and dirty cardboard covered by a pink and white incontinence disposable pad to cover the back of the toilet which poses a potential health, safety, or personal rights risk to persons in care. LPAs took pictures of the back of toilet and the cover that was placed on the back of toilet. LPAs found the window seals in the living room and kitchen area had a buildup of dirt and debris as well as a black colored substance which poses a potential health, safety, or personal rights risk to persons in care. LPAs took pictures of the window seals. LPAs found that in bedroom #2 the flooring near the sliding door was peeling up from the surface. The flooring is lifting, has cracks, and has dirt and or debris coming out of it with a dark colored appearance which poses a potential health, safety, or personal rights risk to persons in care. LPAs took pictures of the flooring. LPAs found a hole in kitchen wall. The hole is located above the cabinets near the refrigerator. The hole has insulation coming out of it which poses a potential health, safety, or personal rights risk to persons in care. LPAs took pictures of the hole in wall. Based on the observations made during today’s visit, five (5) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), three (3) LIC809D forms, and appeal rights were discussed and provided to Caregiver Alexander Angulo.