Routine inspection·April 27, 2022

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced on-site one-year Infection Control Inspection visit to the above-named facility. LPA began the inspection at 10:20 AM. A Mitigation Plan has been submitted to CCLD. LPA was greeted by Administrator, Cecilia Demonteverde and explained the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) and is home to non-ambulatory residents with a dementia diagnosis. There are currently four residents on hospice. Entrance interview conducted: At the time of the arrival, there were 4 staff on duty and 6 residents in care. LPA met with Licensee Cecilia Demonteverde throughout the inspection. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations, and food service. First aid kit was observed to be complete. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. The facility was seen to be in good repair inside and outside. LPA observed a fire extinguisher mounted to the left of the front door entering the facility was serviced on 4/30/2020. LPA observed a fire extinguisher in an unopened box on the floor below the mounted fire extinguisher. During the visit, Administrator Nestor Demonteverde took the expired fire extinguisher and the extinguisher in the unopened box to Nargan Fire & Safety Co, Inc, for fire safety inspection. Per Administrator, the expired fire extinguisher was 6 years old and too old for inspection clearance; the fire extinguisher in the unopened box is a disposable one-time use extinguisher and could not be serviced. Administrator Nestor Demonteverde purchased a new 5 lb extinguisher. LPA observed Administrator obtain a package of two carbon monoxide detectors from the kitchen pantry closet. Administrator stated the carbon monoxide detector located in the hallway was damaged and was knocked off the wall from the residents' wheelchairs. During the inspection at 11:20 am, LPA observed Staff 1 (S1) installed one detector in the kitchen area and one detector Please continue to 809-C. in the residents’ hallway. There are ten hard-wired smoke alarms throughout the facility. The smoke alarms will alert the local fire department when activated. The kitchen area was sufficiently stocked with two-day perishable and seven-day non-perishables. Snacks and beverages are available for Residents in the facility throughout the day and evening. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. The kitchen trash is kept in a receptacle with a foot pedal. Cleaning agents and sharps are kept in a locked cabinet under the kitchen sink. Medications are kept in a locked centrally stored cabinet. The backyard has a covered patio with outdoor furniture, and a shed. At approximately 11:09 am, LPA observed a bucket containing 5 bottles of toxic chemical agents including but not limited to Turtle Wax Seal & Shine, window cleaner, leather cleaner, and carpet cleaner. The container was located next to an unlocked storage shed. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The living room and dining area are neat and clean. The facility maintains a comfortable temperature at 77 degrees Fahrenheit (F). Hallways, bedroom doors and walls are in good repair. The facility has four (4) bedrooms for a capacity of six residents. Bedrooms #1 and #2 are shared bedrooms with a private bath. Bedrooms #3 and #4 are private bedrooms for one (1) resident each. Residents in Bedrooms 3 and 4 share Bathroom #2. All of the bedrooms are furnished with lights and nightstand lamps to provide sufficient lighting. The bathrooms have secure grab bars. There are two private bedrooms for Licensees, Licensees’ family, and staff located behind the kitchen and laundry area. The private staff bedroom area is locked and inaccessible to residents in care. A criminal background fingerprint clearance has been completed for all staff members. Exit interview conducted. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Today’s report and Appeals Rights were reviewed and emailed to Administrator Cecilia Demonteverde.