Routine inspection·March 1, 2022

Licensing Program Analysts (LPAs) Maja Jensen and Avelina Martinez arrived unannounced at facility on 3/1/22 at 9:45am for a one year required annual visit. LPAs spoke with Administrator Lizeth Guerrero and informed her of the purpose for today's visit. Upon entering the facility risk assessment questions were asked and LPAs confirmed there are no active COVID cases at this time. The facility is licensed to serve a total capacity of 80 non ambulatory residents, today's census is 64 with 10 hospice residents in compliance with licensure and fire clearance. 7 of 7 were staff observed cleared and associated in Licensing Information System. Administrator's certificate expires on 6/19/2022. LPAs toured the physical plant inside and outside to ensure the safety of the residents. LPAs observed a resident room, restrooms, nurse's room where medication is stored, dining room, activity areas, patio, kitchen, staff offices, and common restrooms. There is a coy pond at the resident patio that is surrounded by a wrought iron fence and locked. The patio was clean and clear of hazards. The front entrance of the facility has a water feature covered with plexiglass for resident safety. LPA verified the last fire drill was conducted 2/28/22. The temperature inside the facility was measured between 74 and 78 degrees which is within the required range of 68*F and 85*F. LPAs Maja Jensen and Avelina Martinez reviewed 3 staff files and 3 resident files which were observed to be complete with all necessary documentation. LPAs observed COVID related signs and sanitizer posted along the walls throughout the facility. LPAs also observed "see something, say something", Ombudsman and personal rights signs posted in a high visibility area of the facility. LPAs observed lunch service and engaged with various residents throughout the facility. LPAs observed three refrigerators ranging in temperature from 35 to 41 degrees. LPAs also observed the freezer and dry pantry to be organized and sanitary. There is a menu posted daily and vegetarian options are offered. LPAs observed the facility to have in excess of a 2 day supply of perishable food and a 7 day supply of non-perishable food along with emergency supplies. The kitchen fire suppression system was inspected 9/21/22 and is in compliance. continued............ LPAs observed the kitchen hood to be clean and sanitary and was last inspected in December of 2021. The dishwashing area was observed to be sanitary and a dish temperature log is maintained and was observed to have consistent temperature readings of approximately 160 degrees. The employee breakroom was observed to be clean and in good repair with hand washing signs posted. A computer room was observed for residents with access to internet and in compliance with legislation. LPAs observed a second dining room that is being remodeled with access restricted to contractors only. The remodel is scheduled for completion on 3/2/22. LPAs observed mask signs posted in elevators. LPAs observed carbon monoxide and fire alarms throughout the facility. LPAs observed a dip in the floor on the second level and a dip on the third level. Administrator Lizeth Guerrero advised that the facility is the process of leveling and replacing carpet on the second. LPA Maja Jensen has asked facility to also level the flooring on the third level of the facility by the main elevator. LPA Maja Jensen has requested evidence of repair on the second floor by 3/15/22 and a bid for the third floor leveling. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed or cited. Exit interview was held, a signature on this form acknowledges receipt of these documents and a copy of report was given.