Routine inspection·February 3, 2023

Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and was greeted by lead staff, Mercedita Manalo; Licensee, Matilda Verano was contacted and arrived later in the visit. The facility currently provides care for 6 residents all of which were present at the time of visit. There are currently 2 residents receiving hospice services and some of which with a of diagnosis of dementia. LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with lead staff. Facility was at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers were found to be last charged on 1/20/2023 at the time of the visit. Smoke and carbon monoxide detectors were tested and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations with food stored and labeled properly. Residents are provided various alternative food options per meal with the facility ensuring well balanced and nutritious foods. Residents were observed to be resting in their respective bedrooms or in the kitchen area participating in art activities. All resident bedrooms have appropriate lighting and furniture with a supply of extra blankets and linens. There was a supply of hygiene products and paper products available for resident use. LPA conducted a sample review of staff training and found that all staff have current CPR and 1st Aid training on file. Toxins are stored in a locked cabinet in the facility garage and under kitchen sink found to be secured. LPA observed sliding door auditory alarm sound to be low and in need of battery replacement. Technical Violation issued. Licensee to submit LIC9098 Proof of Corrections to CCLD. Continued onto LIC809-C During the inspection LPA Tobola found that resident (R1) had recently been diagnosed as bedridden but currently in a non-bedridden cleared room. The Licensee has been working with Fire Inspector to update fire clearance and potentially modify exits. Upon review of resident (R1) records, LPA found that R1 was deemed bedridden due to ulcers. However, the ulcers were temporary and have been healed. Licensee agrees to update R1's Physician's Report to determine ambulation status. In addition, Licensee will provide updates to CCLD regarding Fire Clearance decision. LPA requested for Fire Inspector contact information to follow up. Infection Control: Facility has submitted an infection control plan for review. Posters have been placed at the front door, and facility has a station near facility entrance with a sign in sheet, hand sanitizer and other items designated for visitors and staff. All staff and visitors were observed to have appropriate face coverings and following facility COVID protocols. No deficiencies cited during today's visit. LPA requested the following documents be sent to CCL by COB 2/17/2022: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility client’s/client’s Copy of Administrator Certificate(s) Copy of Liability Insurance