Routine inspection·October 25, 2022

Licensing Program Analyst (LPA) Alviso conducted a Required 1-Year inspection and met with staff Oralia Vera . Staff Oralia contacted the Administrator German Sinitsyn. The Administrator arrived shortly after being notified of LPA's arrival to complete an inspection. LPA observed activities going on when entering the facility upon arrival, most residents of the facility were participating. There were eleven (11) residents in care at the facility. This inspection is focused on the Infection Control procedures and practices of this facility. Facility has a fire clearance for twelve(12) nonambulatory, of which three(3) may be bedridden. Facility has a hospice approval for four(4) residents. Facility has an approved Dementia Plan of Operation. Licensee has submitted the required Infection Control Plan. Facility was found to be clean, orderly, and at a comfortable temperature with all exits free from obstruction. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed. Toxins/cleaners were locked up, and inaccessible to residents in care. Medications were locked up, and inaccessible to residents in care. All bathrooms had grab bars, and non-slip mat/flooring for bathing as needed. Facility has a sufficient supply of personal protective equipment(PPE). Administrator and the staff on duty all had masks on during the LPA's inspection. LPA discussed information Department PINs regarding visitation, continued screening, infection control procedures in the facility, and requirement of wearing an appropriate mask, staff, and visitors. The LPA observed that staff were not screening visitors, and had not screened the LPA until the LPA asked staff to do so. LPA asked the staff to screen all visitors as required. LPA reviewed with the staff Oralia the screening requirement, including temperature being taken and ensuring to log all information. This deficiency will be cited, 87405(d)(2) Administrator Qualifications and Duties-see LIC809D. LPA are requesting the following documents be updated and submitted to CCL by 10/31/22: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E - Emergency Disaster Plan LIC999- Facility Sketch-Floor Plan Copy of Current Liability Insurance Copy of current Administrator Certificate 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. Exit interview held with Administrator German Sinitsyn.