Follow-up·August 24, 2021

Licensing Program Analyst (LPA) Adam Hamer conducted a case management visit on today's to check on the welfare of the residents in care. LPA arrived at the facility, spoke with Caregiver Ma Guinto and was granted entry after identifying himself and disclosing the purpose of the visit. Ms. Guinto was not wearing a mask and no screening was done prior to or at any point thereafter during LPA's visit. LPA conducted a tour of the facility, inside and out. During the tour, LPA observed one ambulatory resident in the living area adjacent to the kitchen (resident #1 - R1), another non-ambulatory resident in the living area (resident #2 - R2), and four (4) residents in their rooms with their doors open (R3, R4, R5 and R6)(see LIC 811 - Confidential Names List). In the kitchen area, LPA also observed that there were medications centrally stored in an open, unlocked cabinet near the refrigerator and in an unlocked drawer underneath the kitchen counter, accessible to R1 who was in the living room area. In the drawer, there were pills in two (2) unlabeled, open plastic containers and other resident medications. Interviews with staff (S1) revealed that the medicine drawer and cabinet next to the refrigerator were kept open throughout the day and residents' pills are distributed to each resident from the open pill containers. LPA entered a bathroom next to five of the residents' rooms and observed several containers of various cleaning supplies underneath the sink in the bathroom. The door to the bathroom was unlocked and open prior to LPA entering, and the cabinet was also unlocked and open. (continued on next page) The facility's mitigation plan states that the facility will require staff to wear face coverings; check visitors for temperature and symptoms upon entering the facility; post signs outside the facility, do screening upon entry, and have a sign in policy upon entry of any visitor. Upon arrival at the facility, LPA observed no signage outside the facility. Upon entry, caregiver Ma did not have a mask on, did not check LPA's temperature, did not require LPA to sign in and did not do any screening for symptoms whatsoever. LPA gave Administrator Encabo an advisory with regard to the facility's not being in compliance with its COVID-19 mitigation plan. Based on today's inspection, deficiencies were observed and cited in accordance with California Code of Regulations, Title 22 on the attached LIC 809D form. Also, because these were two (2) repeat violations of the same subsections within twelve (12) months, immediate civil penalties were assessed in the amount of $1,000 for each repeat violation. An exit interview was conducted with Mr. Encabo, plans of corrections were discussed with LPA and developed by the administrator, and a copy of this report, the LIC 809D, LIC 421IM and LIC 811, and Licensee/Appeal Rights (LIC 9058 01/16) were provided to him by email; he expressed that he would send LPA a confirmation email upon receipt of these documents.