Routine inspection·July 7, 2021

On 07/7/2021 at 8:45am, Licensing Program Analyst (LPA) Ashley Boothe spoke with Administrator Lizeth Gurrero regarding facility risk assessment questions who confirmed no staff or clients have experienced symptoms within the last 10 days. At 9:45am, LPA arrived unannounced to conduct a required 1-year Annual inspection. LPA met with Administrator and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 80 non ambulatory residnets, today's census is 63, 9 hospice residents in compliance with licensure and fire clearance. 6 of 6 staff observed cleared and associated in Licensing Information System. Administrator certificate expires on 6/19/2022. LPA interacted with a random number of residents during this visit and observed residents engaging in communal dining and activities. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed resident rooms, restrooms, medications room, dining room, communal areas, patio, kitchen, staff offices, and common restrooms. LPA observed facility last conducted disaster drill on 6/30/2021. The temperature inside the facility was measured at 76*F is within the required range of 68*F and 85*F, or in areas of extreme heat the maximum shall be 30 *F less than the outside temperature. The hot water was measured at 118*F which is not less than 105*F and not more than 120 *F. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA reviewed two MAR's to document medications administered per physicians order. The first aid kit was found in compliance containing: a current edition of a first aid manual, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. Continued from 809. LPA observed a pull alarm system, fire extinguisher inspected on 9/11/2020, smoke and carbon monoxide detectors, central heating and air in the facility, fixed fire suppression system last biannual inspection conducted on 3/12/2021. LPA observed elevator last annual inspection conducted on 10/21/2020. LPA observed emergency evacuation chair lift in stairwell. LPA observed food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times. LPA observed knives and toxins inaccessible to residents. LPA observed COVID precautions and PPE available and stored for facility staff. Upon a file review the following items were discussed to be submitted with any changes annually to be submitted by 7/30/2021. Administrative Organization LIC309 Designation of Administrative Responsibility LIC308 Personnel Report LIC500 Administrator Certificate expires on 6/19/2022. Emergency Disaster Plan LIC610E First aid/CPR certificate Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, a signature on this form acknowledges receipt of these documents and a copy of report was given.