Routine inspection·January 12, 2023

Licensing Program Analyst (LPA) Hansen conducted an unannounced Annual Required – 1 yr. Infection Control inspection and met with Licensee, Darwin Galicia. Facility has 4 residents, 1 with dementia, and 2 residents under hospice care. During tour of facility on 01/12/2023 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. Facility has at least two days of perishable and one week of non-perishable food. During tour with Licensee at 12:15pm, sharps drawer in kitchen was observed to be unlocked and accessible to residents in care (see LIC809-D). Hot water temperature measured between 112.4 degrees F and 114.2 degrees F in 2 out of 2 resident’s bathroom faucets which are within Title 22 acceptable regulation of 105 to 120 degrees F. Facilities Two bathrooms were equipped with non-slip floors and mats for safety and stocked with hand hygiene products. There was a supply of cleaners, hygiene products and paper products available for residents. Resident’s bedrooms have lighting & appropriate furnishings. Fire Extinguisher was found to be last charged on 8/4/2021, not within fire clearance regulations (see LIC809-D). Smoke Detector and Carbon Monoxide Detector were tested and operational. Toxins are stored in a locked hallway closet & during today’s inspection, unlocked cabinet under sink (see LIC809-D). Medications are centrally stored and locked in a closet located in the hallway and inaccessible to residents. Facility maintains a 30-day supply of medication. Disaster Drills have been conducted quarterly with the last one being conducted on 10/2022. Continue LIC 809-C Infection Control: Facility has submitted a mitigation program plan and Infection Control Plan. LPA observed that staff were wearing masks during this visit. Facility has more than a 30-day supply of Personal Protective Equipment (PPE). PPE supplies are located in an accessible place for all staff. In addition, facility has a designated area for visits. Residents have also available Zoom, Facetime, and telephone calls when contacting with family members and others. Staff had all PPE training required on file and have obtained N-95 fit testing. LPA Hansen reviewed Licensing Information System (LIS) with Licensee who informed all is current. LPA advised facility to contact Local County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. LPA was presented with proof of current CPR & 1 st Aid certification for staff. Administrator Certificate is for Darwin Galicia # 6002465735 Exp. 06/01/2023 Facility has a 100% COVID vaccination rate of staff. 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. Appeal of Rights Given. LPA Hansen is requesting Licensee to update and submit the following documents to CCL by 1/27/2023 LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurance