Routine inspection·July 25, 2022

LPA Audrey Jeung toured facility and grounds, consisting of 6 private client bedrooms, each with a half bathroom, and a staff bedroom on the main level, plus 1 common full bathroom. There is an attic that is accessed from staff room by pull down ladder, with 3 rooms and a small room that appears to be an unfinished bathroom. Today, LPA observed that there is a mattress in each of the upstairs rooms; no linens are fitted on mattresses. LPA was not COVID screened by staff upon entry. There is a 2 car garage that is used for storage, and laundry. No accessible bodies of water are present. 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. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 6 residents present, and 4 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, in addition to health screenings, TB test results, and valid first-aid training. Olivia De Guzman is a certified RCFE administrator (x 6/22) that oversees facility operations. Copies of training certificates for 40 hours is observed, as well as check register which shows payment to CDSS for renewal of administrator certificate. The following updated forms/information are requested to be submitted to CCLD BY 8/8/22: • LIC 500 Personnel Report Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on a following page. Also, see 1 Advisory Note for additional observations.