Routine inspection·November 23, 2022

Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and was greeted by staff, Rodger Banzon. Administrator, Rosauro Sabile arrived later during the visit. The facility currently provides care for 5 residents some of which with a of diagnosis of dementia and none of which receiving hospice services. LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with Staff and Administrator. Facility was at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 2/7/2022 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 properly. Residents are provided various alternative food options per meal with the facility ensuring well balanced and nutritious foods. Residents were observed to be engaged with staff in the living room area participating in television and conversation with one another. Along with residents receiving physical therapy services, facility staff have an exercise period for residents with several equipment items offered daily during afternoons. Toxins are stored in a locked cabinet in the facility garage and under kitchen sinks. During in the tour LPA observed two bottles of bleach located in separate restroom cabinets to be accessible to residents (photos taken). Items were immediately secured. There was a supply of hygiene products and paper products available for resident use. All residents bedrooms have lighting & appropriate furnishings. LPA conducted a sample review of staff training and found that all staff have current CPR and 1st Aid training on file. Continued onto LIC809-C Upon observation of resident exit doors, LPA found that one auditory alarm in resident bedroom to be inoperable. In addition, LPA found a damaged door handle lock leading resident bedroom into the garage containing cleaning supplies and other items that could pose danger if accessible. Infection Control Facility has submitted an Infection Control Plan for review. Posters are located at the facility entrance, common areas and restrooms indicating COVID protocols and mitigation. Facility has a station at main entrance with a sign in sheet, hand sanitizer and other items designated for visitors, clients and staff. Staff and clients are also screened on a daily basis for temperatures and symptoms. Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. LPA requested the following documents be sent to CCL by COB 11/30/2022: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate(s) Copy of Certificate of Liability InsuranceI