Routine inspection·April 22, 2022

Licensing Program Analyst (LPA) Walters arrived unannounced for the purpose of conducting a Required 1 Year annual inspection. LPA met with Licensee/Administrator, Estrella Valendo and Acting Administrator, Normita Subalo. This visit will focus on the infection control of this facility. LPA signed into using facility sign in sheet, screening questions were posted next to the sign in sheet. Hand sanitizer and disposable face mask were made available. There were two staff present who were providing care and supervision for 1 resident. Neither staff were wearing face coverings. LPA and EV discussed the importance of wearing mask. LPA toured the facility with EV and observed that the facility was clean and a comfortable temperature. Bathrooms were stocked with paper towel and hand washing supplies. There was a 30 day supply of PPE and incontinence products. LPA reviewed resident and staff vaccination records. Staff have received infection control and PPE training through Local Public Health. Training's were documented. Smoke detectors and Carbon Monoxide detectors were tested and appeared to be in working order. Fire Extinguishers were last serviced 03/30/2022. In review of R1's medication, LPA found 2 medication errors, in which the facility failed to issue resident R1's medication. (pictures taken) LPA also learned that there were two other individuals I1 and I2 residing the facility who were not fingerprint cleared or associated. Per Administrator neither individual are working with the resident in care. Continued on LIC 809 C The facility previously submitted a mitigation plan that was approved by Community Care Licensing, but since then there have been updated regulatory requirements related to infection control prevention and mitigation for communicable diseases. LPA is requesting that the facility submits an updated mitigation plan by 6/30/22. LPA and EV discussed new requirements in PIN 22-13 ASC. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. This report was read and discussed with Esther Penaflor Appeal rights were provided.