Routine inspection·May 20, 2022

Licensing Program Analyst (LPA) Victoria Willis arrived unannounced to conduct an Annual Required inspection and met with Licensee, Joel Trinidad. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival, LPA observed posters outside with screening question. After entry, Licensee asked LPA to check their temperature on a thermometer attached to the wall and LPA filled out a visitor sign in that included standard Covid-19 screening questions and requests visitors to show proof of vaccination per Provider Information Notice (PIN) 21-40-ASC. LPA initiated a walk-through of the facility around 2:00 pm and observed the following: Facility has COVID-19 posters throughout that include hand washing signs in bathrooms. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is located throughout common areas of the facility. Observed staff had masks on during this visit. Commonly touched surfaces are disinfected twice per day. Facility maintains documentation of staff and resident daily temperatures. During walk through LPA observed a staff just outside of a large locked hallway closet. Per Licensee, the staff was a live-in. LPA asked Licensee to unlock the door and when they did, LPA observed a mattress on the floor of the closet. Based on discussion with Licensee, the staff previously slept in the designated staff room but when the Licensee moved into the staff room to provide over night care, they moved the staff to the closet. Facility has a designated visitation area outside and is allowing for visitation in resident rooms per CCL guidance. Staff continues to receive PPE training but have not been N95 fit tested. Per Licensee, they frequently go over donning and doffing of PPE with staff. LPA and Licensee discussed visitation and activities. Continued on LIC809C Continued from LIC809 Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including but not limited to masks, gowns, and hand sanitizer. Facility maintains a 30 day supply of medication. Fire extinguishers were last serviced May 2021 and Licensee has made an appointment to have them serviced in June 2022. Smoke and carbon monoxide detectors throughout facility were tested and operational. Licensee and LPA discussed their Emergency Disaster Plan and Infection Control Plan. Infection Control Plan is due June 30, 2022. Licensee/Administrator to updates of the following by 6/20/2022: LIC 308 Designated Administrator LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of current Administrator's Certificate Copy of Liability Insurance Deficiencies 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.