Routine inspection·September 30, 2022

Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced to conduct an Annual Required inspection and met with Administrator, Angie Smith. Licensee, Larona Farnum arrived later. The inspection is focused on the Infection Control procedures and practices of this facility. LPA arrived at approximately 9:00am and observed the following. LPA was asked to sign in. A notice at the reception desk indicated that visitors would no longer be screened per new guidance. LPA clarified that the new guidance no longer requires staff to verify vaccinations for visitors, but they must still be screened per Provider Information Notice (PIN) 22-28-ASC. Facility has COVID-19 posters throughout that included 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 at least once per dayimes per day. Facility maintains documentation of staff and resident daily temperatures. Facility has a designated visitation area outside and is allowing for visitation in resident rooms per CCL guidance. Facility has included training on infection control and proper usage of Personal Protective Equipment to their annual training. Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has more than a 30 day supply PPE including but not limited to masks, gowns, and hand sanitizer. Facility maintains a 30 day supply of medication. Fire extinguishers were last serviced February 2021. Smoke and carbon monoxide detectors are monitored and serviced through a vendor. Continued on LIC809C Continued from LIC809C Licensee and LPA discussed the recent elopement of resident, R1 from the Memory Care unit. Per review of R1's physician's report, R1 is not able to leave the facility unassisted and has wandering behavior. Licensee and LPA discussed their Emergency Disaster Plan and Infection Control Plan. LPA was provided documents for the recent change of administrator. Licensee/Administrator to submit updates of the following documents by 10/30/2022: LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (review and update) LIC 9020 Register of Facility Client’s/Resident’s 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.