Routine inspection·October 21, 2022

LPA Audrey Jeung toured facility and grounds, consisting of 6 client bedrooms and 4 full bathrooms--3 are for client use. Administrator resides in detached garage, that has been renovated as living space with 2 sleeping rooms. Clothes washer and dryer are located in semi-enclosed structure attached to outside of kitchen/dining area. There is a detached storage shed in back yard. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, staff training and policies, resident monitoring, containment strategies, environmental preparation and cleaning. PPE supply is adequate. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 7 residents present, and 2 staff, plus a new caregiver who is "shadowing;" the administrator arrived during the visit. Two residents are receiving hospice services. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, including current first aid training and health screenings. Edith Muncada is a certified RCFE administrator (x 8/24) that oversees facility operations. The following information/forms are requested to be submitted to CCLD BY 11/4/22: - Administrative Organization (LIC309) - Designation of Administrative Responsibility (LIC308) - Personnel Report (LIC500) - Emergency Disaster Plan (LIC610E) - Proof of current Liability Insurance - Proof of control of property/current signed lease agreement - Infection Control Plan per CCR 87470 Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on a following page.