Routine inspection·October 1, 2021

Licensing Program Analyst (LPA) Cuadra conducted an unannounced Annual Required – 1 yr. Infection Control inspection and a case management to this facility. During today's visit LPA met with Licensee, Eden Relota. LPA conducted a Risk Assessment call with staff prior to the visit. LPA arrived at the facility and had their temperature checked and logged into a sign-in sheet. LPA observed that facility has posters on the front door indicating visitors about updated visitor's policy to protect residents in care. Once inside the facility, LPA observed that staff were wearing masks during this visit. LPA/Licensee conducted a walk-through of the facility and observed Covid-19 posters that included hand washing signs in restrooms. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is kept in the common area of the facility but not throughout due to safety concerns. Facility has multiple bathrooms that are kept stocked with hand hygiene products. Commonly touched surfaces are disinfected at least three times a day. Facility has designated an outdoor area for visitation. Facility has a designated isolation apartment on the facility premises for residents that need to isolate and is able to serve meals and deliver medications. Facility staff have been trained on PPE protocols but not all staff have been N-95 fit tested. Staff and residents are being monitored daily and results are documented in a binder for each month. Facility maintains a 30 day supply of medication. Facility has a 100% vaccination rate of staff and residents. Residents do not typically wear a mask while in the facility, but they do wear masks when in the community. Activities had been reduced to more outdoor areas to prevent the spread of the virus. Residents have access to alternative communications as phone calls and video calls with their families. Facility has submitted their Covid Mitigation Plan and approved on 1/19/21. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including masks, face shields, gowns and hand sanitizer. PPE supplies are located in an accessible place for all staff and more supplies are kept in the garage. Continues on LIC809C... Continued from LIC809... During today's visit, LPA followed up on an incident report received on 9/20/21 regarding resident (R1) who on 9/15/21 around 11am complained to staff that they were having severe stomach pain. Staff contacted 911 immediately and R1 was transported to Kaiser Hospital for further evaluation. Responsible parties were notified. R1 was diagnosed with apendics and scheduled for surgery on 10/6/21. Licensee agreed to submit the following documents by 10/8/21: Designation of Responsibility (LIC308), Liability Insurance and Personnel Report (LIC500). No deficiencies observed during today's visit.