Routine inspection·September 27, 2022

On September 27, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual infection control inspection. Upon arrival, LPA observed the COVID-19 signage posted at the front entrance. LPA met with Administrator, Eva Geonanga and explained the purpose of the visit. LPA was not screened at entry point, however observed visitor sign in sheet. Administrator was unable to provide LPA screening log documentation for staff and residents. LPA toured the facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a single story home with 3 resident bedrooms, 2 full bathrooms, and a staff room. LPA toured the kitchen and observed 2 day perishable and 7 day non-perishable. Medication cabinet was observed to be unlocked and accessible to residents in care. LPA observed kitchen to be equipped with liquid soap, paper towels, and hand-washing signs, however LPA also observed hand-towels and bar soaps. LPA advised administrator to not keep bar soaps and hand-towels in communal areas. LPA toured full bathroom and observed it to be equipped with non-skid mat, grab bar, liquid soap, paper-towels, hand-washing sign. LPA observed trash can with no lids and bar soaps. LPA advised administrator to ensure trash cans have a fitted lid and ensure there are no bar soaps. LPA observed resident rooms and observed 2 shared rooms (bedroom #3 and bedroom #4 indicated on facility floor plan) with beds 6ft apart from each-other and 1 private room (bedroom 2). Bedroom #4 has a full bathroom; administrator removed bar soaps and hand-towels in LPAs presence. Bedroom #3 and Bedroom #4 door alarms leading outside were observed not to be working. According to file reviewed, both residents sleeping in bedroom #4 have dementia and one out of two residents in bedroom #3 has dementia. Staff room observed with two beds, 6ft apart from each-other. Extra linen was observed to be present and first aid kit was observed to be completed. LPA toured the dining room and living room to be clear from any tripping hazards. During the visit, LPA Charitra observed 3 residents in the living room watching television and maintaining social distancing. A comfortable temperature of 72 degrees F is maintained and lighting is sufficient for comfort. CONT. to 809C. LPA toured the garage and observed chemicals to be locked, however LPA observed knives to be unlocked and accessible to resident. In addition, LPA observed washer and dryer to be in good working condition and observed extra food supply present. LPA observed 30-day PPE supply present. Infection control practices are not observed: daily monitoring log for residents and visitors, and face coverings for staff. 87468.1(a)(2)- Personal Rights of Residents in All Facilities- This is the second repeat violation within 12 months. Facility was cited on 9/30/2021 under section 87468.1(a)(2). $250.00 CIVIL PENALTY ASSESSED FOR REPEAT VIOLATION WITHIN 12 MONTHS. LPA requests the following forms to be submitted to CCLD by 10/4/2022: LIC308 Designation of Administrative Responsibility LIC500 Personnel Report LIC610E Emergency Disaster Plan Administrator Certificate Deficiency cited today under California Code of Regulations, Title 22, Division 6, Chapter 8 follows on LIC809D. If cited deficiency is not corrected by the due date, a civil penalty may be assessed. This report was reviewed and discussed with Administrator, and a copy is provided. Appeals Rights were given. Civil penalty was also provided.