Routine inspection·March 18, 2022

On March 18, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Caregiver, Dominique Vivien and Licensee, Stella Diaz Calder and Administrator, Maria Diaz Vivien joined shortly thereafter. LPA explained the purpose of the visit. Upon arrival LPA observed the COVID signage posted at the front door. Administrator was able to provide LPA with screening log documentation for residents, staff, and visitors. LPA observed a dog barking in the facility which resulted to a resident yelling that the dog is loud. LPA toured the facility and ground. LPA observed COVID signage throughout the facility. LPA observed the living room desk to have tools, sharps, and papers disheveled. LPA also observed a wooden gate on the living room floor. LPA Charitra observed 3 camera monitors in the living room. The cameras were capturing video surveillance of the resident's rooms. Administrator was not able to provide LPA with any written consent of resident's agreeing to video surveillance. LPA observed 2 bathrooms at the facility. Bathrooms were equipped with paper-towels and liquid soap. LPA advised caregiver to not keep any hand-towels, bath-towels, or bar soaps in the bathroom and to ensure both bathrooms have a hand-washing sign. There are a total of 5 bedrooms in the facility (2 staff rooms, 3 resident rooms). There is one private room and two shared rooms, with beds 6ft apart or 3ft head-to-toe. LPA observed 2 day perishable and 7 day non-perishable present. LPA Charitra observed the 30-day PPE supply. Medications, toxins stored appropriately and inaccessible to residents, and a comfortable temperature is maintained, lighting is sufficient for comfort. First aid kit was observed to be completed. LPA toured the kitchen and observed sharps drawer to be unlocked. LPA requests the following forms to be sent to CCLD by 3/25/22: LIC308 Designation of Administrative Responsibility LIC500 Personnel Report LIC400 Resident Cash Resources Administrator Certificate LIC610E 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.