Routine inspection·June 22, 2022

Licensing Program Analyst (LPA) Kelly Dulek arrived unannounced to conduct a required annual visit, which has an emphasis on infection control practices and procedures. The LPA met with Licensee Evangeline (Joy) Michayluk and informed them of the reason for the visit. At 09:20AM, the LPA and Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations. Common Areas: There were no obstructions and/or tripping hazards throughout the facility. The facility maintains a comfortable temperature throughout the building. There are fire extinguishers throughout the facility, which were fully charged and last serviced 11/16/2021. The LPA observed staff engaging residents in group activities. All common spaces appeared clean and in good repair. At 09:21AM, the Storage closet, which contains Shampoo & Body Wash, Peri-Rinse, and other personal care items was observed to be unlocked and accessible to residents in care. At 09:42AM, the Linen Closet containing Shampoo & Body Wash, Peri-Rinse, Jergens body lotion, Dove Body Wash, incontinence care cart, and other personal care items was observed to be unlocked and accessible to residents in care. Kitchen: The facility had a sufficient supply of two-day perishable and seven-day nonperishable food at the time of the visit. Food is prepared based on the menu and modified as needed for individual residents. Administrator stated a large monthly food order will be delivered Monday and perishable foods are purchased as needed throughout the month. Snacks and beverages are available for residents at all times. Outside areas: The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. Parking is available for residents and visitors. Resident Rooms: The facility is a one story building. Resident rooms can be designated for either single or double occupancy. All resident rooms have either a private restroom or a "jack and jill" restroom shared with Report Continued on LIC 809-C the adjoining room. At 09:35AM, water temperature in room #105's restroom was measured at 99.8 degrees Fahrenheit. At 09:40AM, water temperature in the"jack and jill" restroom between rooms #103 and #101 was measured at 102.5 degrees Fahrenheit. Administrator indicated the water heater was replaced yesterday and had been set to 120 degrees Fahrenheit. Record Review: At 11:26AM, LPA reviewed records for three (3) residents for documents including but not limited to Physican's Report and Appraisal Needs and Service Plan. One (1) of three (3) residents, who has a diagnosis of Dementia, had a physician's report dated 04/07/2021. Infection Control: Prior to entry to the facility, there is a central entry point for symptom screening and temperature checks for staff, and visitors. Staff and visitors were observed wearing appropriate face coverings throughout the visit. During today’s visit, the LPA spoke with the Administrator regarding the community's infection control practices. The community has an adequate supply of Personal Protection Equipment (PPE) and is able to obtain additional supplies. The community's cleaning protocol is sufficient. This facility has records of staff and resident vaccinations. If needed, the facility has the capacity to designate isolation rooms if there is a confirmed case of COVID-19, as well as a COVID-19 wing. The facility has previously managed COVID-19 active cases and the facility complied with all requirements set forth by the local health department and licensing. Staff are up to date regarding guidelines pertaining to visitation and vaccine requirements. The community's policies and procedures pertaining to infection control were adequate. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted, todays reports, and appeal rights were reviewed and emailed to the Licensee.