Routine inspection·May 27, 2022

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with Licensee Nicholas Ray. LPA/Licensee reviewed PIN 22-07, 22-09, 22-13, 22-15 and 22-16. LPA arrived at the facility and had their temperature checked and logged into a sign-in sheet. However, the staff did not ask screening questions to LPA. 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 was not wearing masks. LPA/Licensee discussed the importance to follow their Mitigation Plan that it was approved on 1/3/22. At approximate 1:00pm LPA/Licensee observed that one out of two bathrooms was being remodel. Per Licensee, he wasn't aware that CCL was required to be notified prior to any remodelation to the facility. LPA/Licensee conducted a walk-through of the facility and observed Covid-19 posters that included hand washing signs. Hand sanitizer were observed in the common area of the facility. Facility bathroom are kept stocked with hand hygiene and paper products. Commonly touched surfaces are disinfected at least two times a day. Facility is able to accommodate a single room for each resident that needs to isolate and is able to serve meals and deliver medications. Facility staff have been trained on PPE protocols and N-95 fit tested. Residents are being monitored daily and results are documented. Facility maintains a 30 day supply of medication. Facility has a 100% vaccination rate and received boosters for staff and residents. Residents do not typically wear a mask while in the facility, but they do wear masks when in the community. On 12/17/21 LPA conducted a Case Management to address staffing issues. However, during today's visit Licensee informed LPA that there is only two staff in the facility schedule including the Licensee. Further actions will be reviewed by the Department. Licensee agreed to provide updates of the following by 6/3/22: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), Liability insurance and Emergency Disaster Plan (LIC610E). 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.