Routine inspection·March 28, 2022

On March 28, 2022, at 2:00pm, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. Upon arrival, LPA did not observe COVID signage posted at the front door. LPA met with Administrator, Teofila Oueis and explained the purpose of the visit. LPA was not screened at entry point and Administrator was unable to provide LPA screening log documentation for visitors. This is a single story facility with 6 resident bedrooms, 1 staff bedroom, 5 half bathrooms, and 2 full bathrooms. LPA toured the facility and grounds with the Administrator. No accessible bodies of water or fire safety hazards observed. Administrator was unable to provide a screening log documentation for staff and residents. LPA observed the bathrooms, all were equipped with paper-towels, liquid soap and hand-washing sign. LPA advised Administrator to ensure all trash cans have a lid. LPA observed the 6 resident rooms. According to the Administrator, all rooms are private rooms and 2 of the rooms are currently vacant at this time. LPA toured the kitchen and observed the locked medication cabinet, however LPA observed the unlocked cabinet with toxins and knives located under the sink. Administrator locked the sharps and toxin cabinet during the visit. LPA observed 2 day perishable and 7 day non-perishable present. LPA observed the kitchen to be equipped with a covered trash can, liquid soap, and paper towels. A comfortable temperature is maintained, lighting is sufficient for comfort. First aid kit was observed to be completed. Extra linen was observed to be present. Administrator was able to show LPA 30-day PPE supply. CONTINUE TO 809C LPA requests the following forms to be sent to CCLD by 4/4/22: LIC308 Designation of Administrative Responsibility LIC500 Personnel Report Administrator Certificate LIC610D Emergency Disaster Plan Deficiency of the Residential Care Elderly California Code of Regulations, Title 22, Division 6 is observed and cited on a LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with the Administrator; a copy is provided.