Routine inspection·February 4, 2022

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced 1 Year Required Annual/ Infection Control visit on this date. LPA was greeted by Nora Casaverde, Caregiver (S1) and explained purpose of visit. Administrator Certificate expires 8/20/2022. LPA and S1, inspected physical plant including but not limited to the main kitchen, residents bedrooms and bathrooms, and dining/ living room areas. Upon entry, sign in sheets were observed to document date and visitors name. Sign in sheets did not include symptom screening for reporting requirements to public health officer and contact tracing. All persons in facility fully vaccinated LPA observed resident practicing social distancing. LPA observed 30 days PPE supply. LPA observed sufficient 7 days non-perishable and 2 days perishable food supplies.. Hot water temperature measured 105.4 degrees in residents bathroom with the S1 which is in required range of 105 to 120 degrees. LPA observed sharps and toxins not locked. Last Fire Drill conduced dated 2/3/2020 Fire extinguisher expires 7/01/2022. Fire alarm and carbon monoxide functional. LPA and S1 observed centrally stored medications. LPA reviewed 3 staff and 3 resident files. Resident emergency contact complete. LPA observed all staff files complete. S1 was missing current first aid certificate. S3 was missing a current health screen and TB test. Immediate Civil Penalty of $500.00 for individual not fingerprinted visiting in facility. Per California Code of Regulations, Title 22 Division 6, Chapter 8, the following deficiencies are being cited today in violation of California Code of Regulations. If deficiencies are not corrected by the noted due date civil penalties may be assessed. Exit interview held with S1 and a copy of reports, appeal rights, and civil penalty left at facility..