Routine inspection·February 15, 2022

On 2/15/2022, around 2:15pm, Licensing Program Analyst (LPA) Mai Thao arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Babita Sharma, care staff and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95. Around 2:15pm, upon entry of the facility, LPA Thao and Care Staff observed the lock on the front door to be a dead bolt lock. LPA asked staff how is the door unlocked. Staff stated that a key is needed to unlock the front door. LPA and care staff confirmed that the door is locked and cannot be unlock without the keys. LPA Thao and care staff toured facility to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, three (3) bathrooms, four (4) bedrooms, kitchen, storage areas. Around 2:36pm, LPA Thao and staff toured the storage room next to the Great Room (common area). The storage room door was observed to be unlocked and opened. LPA and care staff observed 2 bed, and 2 shelves in the room. Care staff stated that the storage room is the staff room. LPA confirmed on facility sketch that this room was cleared by the Fire Marshal as a storage room, not a staff room. Around 2:41pm, LPA observed a drawer in the storage room with medications on top accessible to residents in care (Ferosul 325, Famotidine, Atorvastatin Calcium, Metformin HLC 500mg, Vitamin C + Zinc, Omeprazole 40mg, and other over the counter medications). Care staff stated that these medications belong to care staff's mother who stays in the room. Around 2:44pm, LPA and care staff observed 3 exits of the facility with no auditory devices (front entrance, sliding door in Great Room, and the left door next to the storage room in the Great Room). LPA and care staff observed 2 exits with auditory devices that were turned off and not on when care staff opened the door. Care staff stated that 5/5 residents in care have dementia. Around 3:10PM, LPA and care staff reviewed 5/5 resident files. LPA and Care staff observed 4/5 residents with a diagnosis of dementia. LPA and Care Staff observed 5/5 Needs and Services plan with dates from 2020. LPA and Care staff observed 3/5 residents with a diagnosis of dementia LIC 602 Physician's Report with dates from 2020. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted and appeal rights provided. A copy of this report was left at the facility.