Routine inspection·August 11, 2021

Licensing Program Analysts (LPA) Katrina Walters arrived unannounced to conduct an Annual Required inspection and met with Lead Staff, , Elizabeth Manaois (EM). Administrator/Licensee Samual Padama 6050197740 exp 11/28/22 arrived later. LPA conducted a risk assessment with Staff prior to entering the facility. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. This facility has submitted a Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report (LIC 808), which was reviewed an approved by Community Care Licensing on 4/19/21. Upon entry, LPA signed into the facility sign-in sheet, which included a list of screening questions. Hand sanitizer was also available. At the time of the inspection LPA observed that there were two staff providing care and supervision for 4 residents. 3 residents were socially distanced in the dinning room and 1 resident was in their bedroom with staff. The facility was clean and a comfortable temperature. Per staff the facility is disinfected daily and after every meal. LPA observed that proper signage was posted throughout the facility to promote hand washing and socially distancing. Each resident has a designated visitation area. Facility has a 30-day supply of Personal Protective Equipment (PPE), medication, and incontinence care supplies for all residents. Continued on 809 C Continued from 809 All staff are routinely trained on infection control and on how to don and doff PPE from Solano County Public Health. In addition all staff have been fit-tested. Smoke detectors and Carbon Monoxide detectors were functioning properly. At 4:52 PM LPA observed that both facility Exit gates were obstructed with a rope and the other exit with a latch. LPA was unable to open either gate. (pictures taken.) Staff were present. Administrator immediately removed the rope and latch that were placed on the facility EXITs. Facility Administrator understands they will need to request and have fire department clearance and CCL approval before locking an EXIT. An immediate civil penalty for $500.00 was issued today for obstructing two facility EXITs. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and or Health and Safety Code. 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 Administrator, Samual Padama. Appeal rights were provided.