Routine inspection·August 19, 2022

Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and met with Administrator, Neil Lomboy (NL).The facility currently provides care for 6 residents some of which with a of diagnosis of dementia and one of which was admitted to the hospital. LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with Staff, Alex Ordonez (AO) and Administrator. Facility was at a comfortable temperature. resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 3/31/2022 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. All staff have current CPR and 1st Aid training on file. LPA observed live in staff bedroom to be locked and secured. Toxins are stored in a locked cabinet in the facility garage and under bathroom and kitchen sinks and found to be secured. There was a supply of hygiene products and paper products available for resident use. All residents bedrooms have lighting & appropriate furnishings. Water temperature was measured at faucets accessible to residents and was measured at 105.0 degrees F which is within regulation between 105 and 120 degrees F. Upon record review, LPA found resident's (R1) Physician's Report (LIC602) with a diagnosis of dementia. Administrator stated that R1 did conduct a virtual visit with their physician with visit result documents provided but was not able to conduct updated LIC602. Administrator will be contacting R1's primary care provider to schedule additional visit to update R1's LIC602. LPA issued Technical Assistance. Continued onto LIC809-C Infection Control: Facility has submitted Infection Control Plan for review. Resident has been relocated to hospital for COVID diagnosis. Facility has conducted mass testing and all other staff and residents are currently negative. Facility has notified and working with Solano Public Health. Posters have been placed at the front door, and facility has a station at main entrance with a sign in sheet, hand sanitizer and other items designated for visitors and staff. Staff and clients are screened for temperature and symptoms on a daily basis. LPA requested the following documents be sent to CCL by COB 8/26/2022: 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 Insurance No deficiencies cited during today's visit.