Routine inspection·February 7, 2022

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA spoke with Desrene Hall, caregiver, and observed her to be wearing a mask. Caregiver contacted Robert Tif, Administrator by phone, who arrived shortly to the facility. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms Additionally, LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering. The following Personal Protective Equipment (PPE) was worn: N95 Mask. LPA observed (2) residents watching television in the common area and (2) residents resting in their rooms. No residents are currently receiving hospice services. LPA and caregiver toured and observed the facility to ensure the health and safety of residents in care. Areas toured include: common areas, (2) private bedrooms, (2) shared bedrooms, (2) resident bathrooms, (2) vacant private rooms, (1) staff/break room, dining room, laundry area and kitchen. LPA observed 2+day perishable and 7+day non-perishable food supply and PPE supplies for 30+days on hand. LPA observed locked toxins, medications and sharps. In the areas toured, there were no immediate health, safety, or personal rights violations observed. LPA and Administrator completed the infection control domain. Inside temperature was observed to be 73* F. LPA observed several Covid posters posted at/near the front entrance and in the bathrooms -LPA to provide additional posters to post throughout. LPA observed other required postings in place. Administrator Certificate #6047124740 posted (exp 2/9/2022)- Administrator showed proof of mailing receipt for renewal. Fire extinguisher last serviced 7/14/2021. Administrator to check his records if a mitigation plan was submitted and has not approved yet- will submit by Friday, 2/11/2022. Liability insurance was not renewed prior to expiration. Discussed vaccination status of residents and staff as well as PIN 22-04 issued 1/18/2022 regarding current testing and visitation requirements. LPA requested completed LIC308 be emailed to the Department by 2/11/22. Per California Code of Regulations, Title 22, Chapter 8, Division 6, the following (2) deficiencies were issued. See 809D for citations issued. Exit interview. Copy of report and appeal rights provided to Administrator at facility.