Routine inspection·August 23, 2022

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, Administrator, Lina Fojas. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. There are currently 5 residents in care. This facility is licensed for 6 non ambulatory residents, with hospice waiver approved for 3 of the residents and none of the residents are approved for bedridden. LPA toured facility and grounds and observed COVID-19 precaution signs posted in common areas. LPA was screened for COVID-19 symptoms upon entrance to this facility. Visitors are said to be screened for COVID-19 symptoms upon arrival to the facility. Infection control practices are present: entry procedures, face coverings, daily monitoring and temperatures checked for residents and staff, and 30-day PPE supply. Facility to follow indoor visitation requirement of verifying and tracking COVID-19 vaccination or verify non-essential visitors have proof of a negative COVID-19 test. Facility states staff clean and disinfect the facility daily. Bathrooms are equipped with liquid soap and paper towels and required hand washing postings. Covid-19 Mitigation plan was reviewed by Community Care Licensing department on 2/5/2021. Facility has also submitted their Infection Control plan, that will be part of their plan of Operation. Caregivers have completed PPE training but have not been N-95 Fit tested. In addition, facility was found to be at a comfortable temperature. Facility has at least two days of perishable and one week of non-perishable foods and items are stored properly. Fire Extinguisher was found to be charged and purchased on May 25, 2022. LPA went over reporting requirements for incident reports to be submitted to CCL within 7 days. During todays visit LPA discovered facility has had several resident incidents and a Death report that has not been submitted and facility has also failed to notify Community Care Licensing (CCL) of new Hospice intake as required. Continue report see LIC809-C LPA toured the 2nd floor of the facility, there is a rope across the bottom of the stairs to prevent access to any residents going up. The top floor is not used by residents, LPA observed two bedrooms in the second floor. The first floor of the facility has 4 bedrooms that were approved for residents to use. Bedroom #1 has an adjacent room before entering room #1 and that room was not identified as a bedroom and the facility has a twin bed set up. LPA requested staff open a locked closet door in resident room #4 and observed two twin beds set up as an L shape with personal belongings, clothing, shoes, cell phones charging, personal medications and framed picture. The master bedroom closet for resident (R1) was being used as a staff bedroom. Facility immediately removed both beds and all personal belongings during LPA'S visit. This is an immediate Fire safety violation, Zero tolerance and a civil penalty was issued in the amount of $500.00 during today's inspection. The staff beds in the first level of the home where removed, Administrator was advised, the facility will need to ensure they have awake staff during the night to provide care and supervision to all resident in the first level of the home until the facility can install a call button system that can alert the staff in the second level of the facility; where staff bedrooms are located. Administrator to inform CCL LPA once auditory call system has been installed. LPA requested the following updated records to be submitted to Community Care Licensing (CCL) 9/19/2022. · LIC 308 Designation of Facility Responsibility · LIC 500 Personnel Report · LIC 610 Emergency Disaster Plan · LIC 9020 Register of Facility Residents Copy of administrator certificate; Copy of liability insurance; Copy of current Lease/Rental Agreement See report LIC809-D for 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. Appeal rights were provided. A civil penalty was applied for $500.00 for fire safety, Zero Tolerance . Exit interview conducted with Lina Fojas.