Routine inspection·November 9, 2021

On 11/9/21 at 1:16pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Brandon Rose and explained the purpose of the visit. LPA Bilger inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is a 5 bed facility with a current census of 5. LPA also conducted the infection control domain tool. The facility has an approved COVID Mitigation plan LIC 808 form in place.The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and outside including entry way. The facility has a designated infection control lead. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. Water temperature reads 110.1*F in the bathroom and room temperature reads 77*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 11/20/2020. Facility has an emergency food and water kit. Administrator certificate expires 6/4/2022. Sharp objects were noted to be accessible to residents in care during LPAs visit. {Cont. on LIC 809C} Resident medications observed to be accessible to residents in care. Physician's report and appraisal needs and service plans were not updated in 3 of 5 resident records reviewed. Four staff records were reviewed. All staff first aid and required training is updated. All staff fingerprints cleared. Per California Code of Regulations, Title 22, deficiencies were observed during this visit as noted on LIC 809D. Exit interview was held with Brandon Rose and a report along with appeal rights was given to Administrator Brandon Rose