Routine inspection·November 17, 2022

Licensing Program Analyst (LPA) Canela arrived unannounced, to conduct an Annual Required 1 YR inspection and was greeted by care staff, Linda Ramos. Administrator/Licensee Rose Devera arrived a few minutes later. The inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. Upon arrival, LPA observed that facility has Covid posters on the front door. LPA discussed visitation procedures with administrator, documenting & screening questions. Once inside the facility, LPA observed that facility has a sign-in for visitors, screening area with PPE . Staff wear masks inside the facility. LPA conducted a walk-through of the facility and observed Covid-19 posters that included hand washing signs in restrooms, but no paper towels. Facility was a comfortable temperature. Residents are encouraged to wear masks when in the community. Commonly touched surfaces are disinfected throughout the day. Facility staff have been trained on PPE. Facility has submitted their Covid-19 Mitigation Plan and it was approved. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including but not limited to masks, face shields, gowns and hand sanitizer. PPE is in a location that is stored and accessible to staff. Facility maintains a 30 day supply of medication. LPA observed the, "if you see something say something" complaint poster, but the poster is not the required size 20"x26". Facility will need to get and post the correct size, failure to correct will result in citation being issued. Continue report See LIC809-C LPA requested the following updated records to be submitted to Community Care Licensing by 12/15/2022: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), LIC 9020 Register of Facility Residents Liability Insurance Certificate and Emergency Disaster Plan (LIC610E). In addition, facility to send in the following information to LPA Araceli Canela by 11/21/2022: current facility sketch , correcting size of rooms, use of room by staff or residents, ambulatory, non -ambulatory or bedridden use. Facility to identify all rooms on sketch and use of room in garage. Facility to also provide current Administrator information and copy of Administrator certificate. During today's visit staff S1 had a fingerprint clearance, but was not associated to the facility as required. Staff S1 did not have a current health screeing and proof of negative TB test. LPA consulted regarding all the items that are being placed behind doors that may prevent exit doors to open properly and requested facility to move items during the inspection. Facility understands that this may be a fire safety violation and result in citations and civil penalties. LPA also consulted regarding a front door deck piece of wood that felt loose and will need to be secured, firm and in good condition. LPA also requested facility to review right side of yard where a couple of bricks are sticking a little higher than the others and could be a tripping hazard or will not allow a wheel chair to go through easily. Facility to notify LPA of corrected status. 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 assessed during todays visit for $100.00 for S1 not being associated to this facility. Exit interview conducted with Rose Devera, Licensee/Administrator. This report was emailed to facility during this visit.