Routine inspection·July 12, 2022

On July 12, 2022, Licensing Program Analysts (LPA) Komal Charitra conducted an unannounced annual infection control inspection. LPA met with Administrator, Ana Marie Arevalo and explained the purpose of the visit. Upon arrival, LPA was screened at entry point and observed the COVID-19 signage posted on the front door. Administrator was able to provide LPA with screening log documentation for visitors, however was unable to provide screening log documentation for staff and residents. LPA toured the facility and grounds. No accessible bodies of water or fire safety hazards observed. LPA observed one staff member during the visit without a face covering. This is a single story home with 3 resident bedrooms, 2 staff bedrooms and 2 bathrooms. LPA observed 2 out of 3 resident bedrooms to be shared rooms with beds 6ft apart. LPA observed the bathrooms to be equipped with hand-washing signs and liquid soap, however advised Administrator to remove bar soaps, hand-towels, bath-towels, and ensure trash cans have a fitted lids and paper towels in all shared bathrooms. LPA observed the COVID-19 signage posted throughout the facility. LPA observed medications and toxins locked and inaccessible to residents. LPA toured the kitchen and observed 2 day perishable and 7 day non-perishable present. LPA observed sharps drawer to be unlocked and accessible to residents. A comfortable temperature is maintained and lighting is sufficient for comfort. First aid kit was observed to be present and first aid cards were observed to be current. LPA toured the garage and observed washer and dryer to be in good working condition. LPA also observed the 30-day PPE supply present. CONT. to 809C. LPA requests the following forms to be sent to CCLD by 7/19/22: LIC308 Designation of Administrative Responsibility LIC309 Administrative Organization LIC500 Personnel Report LIC610E Emergency Disaster Plan Administrator Qualifications 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.