Routine inspection·July 20, 2022

Licensing Program Analyst (LPA) Dina Alviso conducted 1 year required inspection and met with Licensee Administrator Lza Biscocho. The inspection is focused on the Infection Control procedures and practices of this facility. There were five(5) residents in care at the facility during this inspection. There is an approved hospice waiver for three (3) residents. Facility has an approved dementia plan of operation. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden. Administrator recently submitted the facility's new Infection Control Plan as required. All visitors, essential visitors, and staff are screened upon entry; Temperatures are taken, and screening questions are to be answered before being allowed to remain in the facility, all information is logged. Residents are screened and observed for any changes, all information is logged. Facility was found to be clean, orderly, and at a comfortable temperature. Toxins are stored in locked cabinets. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed. Medications were stored locked making them inaccessible to residents in care. All exit alarms were on exit doors and working properly during the inspection. All smoke alarms(9) were checked during the inspection and working properly. One of the smoke alarms in the hallway is also a carbon monoxide alarm, it was working properly when checked. All bathrooms had grab bars, and non-slip mat/flooring for bathing as needed. There was a sufficient supply of food. All postings were up and visible to all as required. Facility has a sufficient supply of personal protective equipment(PPE) for staff use as required. LPA observed the Administrator and caregiver on duty, had masks on as required. LPA observed a wheeled seating/walker blocking an emergency exit door in the resident's room. This deficiency will be cited, Fire Safety 87203-see LIC809D. It was made known to the LPA when obtaining information from the Administrator regarding a facility incident report that a staff (S1) has declined to be vaccinated and S1 doesn't have the required valid exemption. This deficiency will be cited, Health & Safety Code 1550(c) -see LIC809D. LPA are requesting the following documents be updated and submitted to CCL by 7/27/22: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610 - Emergency Disaster Plan Copy of Current Lease Agreement Copy of Current Liability Insurance Copy of current Administrator Certificate when received Deficiencies 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 with the Administrator. Appeal rights provided to the Administrator.