Routine inspection·July 19, 2022

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced on-site one-year Infection Control Inspection and Annual visit to the above-named facility. LPA arrived at 2:34 pm and was greeted by Chamila Ruwanpathirana, Administrator. At the time of arrival, there were 4 residents in care and 3 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 and one bedridden resident. Currently, there are no residents 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 kits were observed to be complete. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. There is one fire extinguisher on the premises last serviced on 3/22/2022. There is a total of one carbon monoxide detector and nine smoke alarms throughout the facility all in good working order. Snacks and beverages are available for residents in care upon request. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. Cleaning agents and the toxic chemicals are kept in a locked laundry room off the kitchen area of the facility. Medications and sharps are kept in a locked cabinet and drawer in the kitchen area. The backyard has a covered and paved patio with outdoor furniture and a locked shed. The front yard has paved walkways, garden areas and a sitting area. The front and back yards are conducive for outdoor visitations. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. Please continue to 809-C, Pg 2. At 3:08 pm, LPA observed 2 gas cans containing gas, gardening equipment (weed eater, hedge trimmer, lawn blower, and rakes), and a discarded toilet and walker located on the northside of the facility. Upon arrival at 2:34 pm, the room temperature was measured at 83 degrees Fahrenheit. Hallways, bedroom doors and walls are in good repair. The living room and dining area are neat and clean. LPA advised Administrator that the facility should maintain a comfortable and cool environment at all times. The facility has five (5) bedrooms for a capacity of six residents. Bedroom #1 has a private bathroom. Bedrooms 2 and 3 utilize a bathroom at the end of the hallway. Access into Bedrooms 5 and 6 is through the facility office with access into the bathroom next to the facility office. All of the bedrooms are furnished with lights and nightstand lamps to provide sufficient lighting. All persons associated with the facility have a criminal background clearance. At 3:16 pm, LPA observed signage indicating visiting hours to the facility are from 10:00 am – 4:30 pm with a call is requested prior to the visit. 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. A copy of the report and appeal rights have been issued via email