Routine inspection·August 3, 2022

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced on-site one-year Infection Control Inspection visit to the above-named facility. LPA arrived at 12:17 pm and was greeted by Staff 1 (S1). Administrator Lidia Kravchuk arrived at approximately 12:32 pm. At the time of arrival, there were 6 residents in care and 2 staff on duty. A Mitigation Plan has been submitted to CCLD. LPA 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 2 residents currently on hospice. Entrance interview conducted: 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. Entrance interview conducted. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked. The facility was seen to be in good repair inside and outside. Fire inspection was most recently conducted on 6/15/2022. There are approximately eight (8) hard-wired dual carbon monoxide detectors/smoke alarms throughout the facility. The alarms will alert the local fire department when activated. The kitchen area was sufficiently stocked with two-day perishables and seven days of non-perishables. Snacks and beverages are readily available for Residents. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. Medications are kept in locked cabinets in the kitchen area. A fire extinguisher and First Aid kit are kept in the hallway at the rear entrance into the facility. Please continue to 809-C, Pg 2. Residents participate independently in games, puzzles, coloring, and corn hole toss. The front yard is well maintained and consists of walkways and garden areas. The backyard is well maintained and has a paved patio, gazebo, and garden areas with walkway surrounding the parameter of the facility. The backyard is conducive for outdoor visitation. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. Chemicals and cleaning supplies are kept in a locked cabinet under the kitchen sink. The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable temperature. Hallways, bedroom doors, and walls are in good repair. There are six private bedrooms available for six residents. Each bedroom has a private bathroom. There is a live-in staff room off one hallway that remains locked throughout the day and night. At 12:21 pm LPA observed Staff 1 (S1) not wearing a mask while in the facility. S1 put on a mask per LPA’s request. At 12:23 pm, LPA observed Staff 2 (S2) not wearing a mask while in the facility. S2 obtained a mask from the kitchen area and complied with LPA’s request. All persons associated with the facility have a criminal record clearance and have been properly associated to the facility. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted. Copy of this report and Appeal Rights issued via email.