Routine inspection·June 2, 2022

Licensing Program Analysts (LPA) Fernandes-Goes conducted an unannounced Annual 1 yr. Required & Case Management Non-Compliance Infection Control inspection to this facility and was welcome by staff Jesus Brioles. Facility has 4 residents with no one on hospice care at this time. Facility has activities for residents during the day. LPA arrived at the facility and had her temperature checked and logged into visitor’s binder. During facility tour on 6/2/2022 with staff Jesus Briones, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, garage, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 1/2022 at the time of the visit. LPA conducted a sample test of Smoke Detectors & Carbon monoxide detector and they were operational. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator was properly stored as per regulations on this day at the time of the visit. Facility has no residents with special dietary need at this time. Food is available for residents any time of the day. Facility takes residents on walks, and conduct activities during the day such as singing. LPA observed during this visit unlocked toxins – Lysol under residents' bathroom and several different toxins under kitchen sink which is not locking properly. LPA was able to open the under-sink door without magnetic device. In addition, staff room wasn’t locked and had over the counter medications unlocked on top of dresser and unlocked garage with unlocked toxins. Sharps such as knives and scissors were found unlocked in a kitchen draw and countertop while staff S1 and S2 on shift were touring facility with LPA. Facility at this time has 2 out of 4 residents with a diagnosis of dementia. There was a supply of cleaners, hygiene products and paper products available for residents. (see copies, Picts, LIC 809-D) Continued LIC 809-C All bathrooms designated for residents at the facility were supplied with single paper towels and hand soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. A sample tour of resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing. Facility hot water temperature at residents' bathroom faucet measured between 118.8 degrees F and 120 degrees F in 2 out of 2 residents’ faucets within Title 22 acceptable regulations of 105 to 120 degrees F. All staff on shift during this visit is fingerprint cleared and associated to facility. During residents' file review due to unlocked toxins and sharps, LPA learned that there are 2 out of 4 residents' with reappraisals over 12 months. Resident R1 – diagnosis of dementia most resent reappraisal dated 9/28/2020 and Resident R3 – diagnosis of MCI reappraisal dated 11/2/2020. (see copies, LIC 809-D) Infection Control: Facility has submitted a mitigation program plan that has been approved. Posters have been placed at facility and entrance has table with hand sanitizer and other items designated for visitors and staff before coming into work. Facility has PPE supply stored in small storage cabinet in living room. Facility has hired staff and admitted new residents since COVID-19. Residents’ medications are stored and locked in kitchen cabinet. Facility has a 30-day supply of medication for residents. Residents aren’t wearing masks inside the facility, however; licensee/admin stated that they are able to wear masks when going on outings. All staff had masks on during this visit. Visitors are being allowed in the facility. Residents have also available virtual and telephone calls when contacting with family members and others. Staff stated that all PPE training required and N-95 fit testing are on file. Disaster Drills have been conducted quarterly with the last one being conducted on 5/10/2022. Facility still has pending updated fire clearance. LPA contacted Fire Marshall AT who stated that another visit will be conducted. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and 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. Exit interview conducted and appeal of rights provided.