Routine inspection·March 10, 2022

Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and was greeted by Licensee, Alicia Poquiz (AP). The facility currently provides care for six (6) residents none of which with a diagnosis of dementia. LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with Licensee and facility staff; facility was found to be clean and 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 6/9/2021 at the time of the visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored under kitchen and bathroom sinks and in the garage. LPA observed Lysol and Spic and Span cleaning solutions in an unlocked staff bathroom (photos taken). Licensee immediately removed cleaning supply solutions and locked staff bathroom. Residents do not use staff bathroom but LPA explained the health & safety risks that the accessible cleaning supplies may have towards residents. There was an ample supply of hygiene products and paper products available for resident use. All resident’s bedrooms have lighting & appropriate furnishings. Hot water measured at 119.8 degrees F which is within Title 22 regulations of 105 to 120 degrees F in faucets used by residents. Infection Control: Facility has submitted a mitigation program plan which has been approved. All staff and residents have been vaccinated with no reported or observed symptoms. Posters have been placed at the front door, and facility has a station at main entrance with a sign in, hand sanitizer and other items designated for visitors and staff. Staff are screened for temperature and symptoms on a daily basis and residents are screened on a daily basis. Continued onto LIC809-C 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. Exit interview conducted with facility Licensee, whose signature on this document confirms receipt. A copy of the signed report was emailed to Licensee.