Routine inspection·May 16, 2023

Licensing Program Analysts (LPA's) Kesha Lewis at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA was met by Staff member and Administrator joined 15 minutes later. LPA were screened upon entry for COVID precautions. LPA explained the purpose of the visit to Administrator. Administrator's Certificate # 6019316740 Expires 07/25/2024. LPA and Administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 5. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. The hallway has COVID precautions in place including social distancing noted. Chemicals and medications noted to be locked to residents in care. LPA also conducted the infection control domain tool. Hot water temperature was measured at 105 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. The facility submitted a LIC 808 mitigation plan, which was approved. 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 stations, COVID - 19 informational signage, and social distancing signs posted throughout the facility, on the front door, and outside. The facility has a designated infection control lead individual. The facility is able to designate and dedicated a COVID -19 room/bathroom if needed. Common touch surfaces are cleaned after each use. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. LPA observed, fire extinguishers inspected on 08/30/2022 and current, smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. LPA reviewed three (3) staff files. All staff is fingerprint cleared and associated to the facility after review of staff records LPA observed that only one (1) Staff member had a valid CPR and first aid certificate and it was not the staff member working at the time. LPA reviewed three (3) resident facility files, COVID-19 Plan, and survey binder. All necessary documents were in place. Administrator Maria Arcal will stay at the facility until another staff member has valid CPR. The following deficiencies are being cited Per California Code of Regulations, Title 22, Division 6, Chapter 8. See 809D page. Exit interview held with staff and copies of reports left at conclusion of visit.