Post-licensing visit·May 12, 2022

Licensing Program Analyst (LPA) Hansen conducted an unannounced post-licensing infection control inspection to this facility and was welcome by staff Marita Socito. Staff called Administrator Darwin Galicia who arrived approximately 30 minutes later. Facility has 4 residents with 2 under hospice care at this time. S1 greeted LPA by opening the front door, S1 was observed not wearing a mask and S2 walked around the corner, into the front room also without a mask on. LPA requested S1 & S2 put masks on and discussed the mandated requirement to wear the mask in the facility. LPA observed hand sanitizer at the entrance and a log in binder for temperatures of visitors and answering questionnaire. During tour the facility on 5/12/2022 with licensee/administrator Darwin Galicia, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Sample tour of resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 8/4/2021. Hot water temperature measured between 110.1 degrees F and 110.1 degrees F in 2 out of 2 resident’s bathroom faucets which are within Title 22 acceptable regulation of 105 to 120 degrees F. Toxins are stored in a locked hallway closet & locked cabinet under sink. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with individual paper towels; hand soap dispenser was available. Sample resident’s bedrooms have lighting & appropriate furnishings. Infection Control: Facility has submitted a mitigation program plan that has been approved at this time. Some posters have been placed at facility entrance. Facility has PPE supply stored in locked hallway closet. Resident’s medications are centrally stored and locked in office cabinet. Facility has a 30-day supply of medication for residents. Residents aren’t wearing masks inside the facility. Administrator stated staff have received PPE training and acquired N-95 fit testing. Continue on LIC 809-C LPA was given names of staff working at the facility. LPA was informed by S2, S2 has been working at facility for 7 months. Administrator informed S2 started 11/2021 and just not associated to the new License but should be completed today. LPA confirmed with CCL it is being worked on. S2 has been working at facility more then 5 days and will be assessed a Civil Penalty. Immediate Civil Penalties are being assessed in the amount of $500 due to staff S1 not being associated to the facility. *****Total Civil Penalties issued today in the amount of $500.00 Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and 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 and appeal of rights provided. Department is requesting the following to be submitted to CCLD by 5/27/2022: LIC 500 LIC 9020 Copy of liability insurance