Routine inspection·August 24, 2022

On 8/24/22, Licensing Program Analyst(LPA) Murial Han and Co-Worker Kevin Gaines conducted an unannounced annual inspection. LPA observed COVID-19 signs posted through-out the facility. LPA met with the administrator, Leonora and explained the purpose of the inspection. LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures- LPA and co-worker's temperatures were taken at the entry, however, it was not observed to be documented. The administrator stated that the daily COVID-19 screening for residents, staff and visitors are completed, however, was not able to provide any documentation. Containment strategies (the facility has dedicated a private room for isolation and quarantine). There are 6 residents at the facility (2 female and 4 male residents). There are 4 residents in the living room. The facility has 3 semi-private rooms and the beds were observed to be 6" apart. PPE supply and the environmental cleaning supply are adequate and stored in different locations; LPA recommended to store in a common area for easy access. Trash cans in the kitchen are observed to be foot operated. Medications, and toxins stored appropriately and inaccessible to resident, a comfortable temperature is maintained, and lighting is sufficient for comfort. First-aid kit is inspected and complete. During today's inspection, LPA and co-worker observed the bathroom is out of service and it is under construction. The administrator stated that the bathroom has piping/plumbing problems and the repair started today. The administrator also stated that it was reported to the resident's responsible parties and their social workers. LPA requested for written plan of the repair to be submitted to CCL by 8/24/22 5pm. The plan shall include but not limited to the scope of work that is being performed, the plan to ensure resident's activities of daily is not interrupted during the repair, when and who were notified, what is the facility's plan to ensure residents are not affected by the repair and the completion date. During today's inspection, LPA and co-worker observed the fire extinguisher in the kitchen was last inspected on March, 2020 and according to the administrator, this is the only fire extinguisher for the entire facility. Based on observation, deficient is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. During today's inspection, LPA requested a copy of the Affidavit Regarding Client/Resident Cash Resource, and LIC 500 (Personnel Report) by 8/29/2022. This report is discussed with the administrator. A copy of this report and the Appeal Rights are provided.