Routine inspection·August 1, 2022

On August 1, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual infection control inspection. Upon arrival, LPA observed the COVID-19 signage posted on the front door. LPA met with Administrator, Dino Martin and explained the purpose of the visit. Administrator was able to provide LPA screening log documentation for visitors, staff and residents. LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a single story home with 6 resident bedrooms, 1 staff room, and 3 full bathrooms. LPA observed all resident bedrooms to be private rooms. Bathrooms were observed to be equipped with liquid soap, paper towels, and a hand washing sign. LPA advised administrator to ensure trash cans are covered with a lid. Infection control practices are present: entry procedures, daily monitoring for residents and staff, COVID-19 signage posted throughout the facility, and 30-day PPE supply. LPA toured the living room and dining room and it was clear and free from any tripping hazards. A comfortable temperature was maintained, lighting is sufficient for comfort. LPA toured the kitchen, medications, toxins and sharps are stored appropriately and inaccessible to residents. LPA observed 2 day perishable and 7 day non-perishable present. First aid kit was observed to be completed. Extra linen was observed to be present. LPA observed the staff room which lead to the garage. The garage was observed to have extra food supply. Washer and dryer was observed to be in good working condition. LPA observed an attic above the garage with clothes and boxes. According to the Administrator, no staff are sleeping in the attic, however is looking into obtaining fire clearance for the attic to be used as a staff room. (CONT. to 809C) It was found during the visit that a staff member (S1) was not associated to the facility. LPA reviewed the staff roster with the Administrator and confirmed that S1 is not associated to the facility but does have a fingerprint clearance. This violation results in an immediate civil penalty of $100.00. LPA requests the following forms to be submitted to CCLD by 8/8/22: 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 with appeal rights.