Routine inspection·February 18, 2022

Licensing Program Analysts (LPA) Angel Ascencio arrived at the facility unannounced to conduct a required annual visit at 11:00 a.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Roberto De La Vega Ramirez a nd discussed the reason for the visit. Entrance interview conducted. The LPA, along with Administrator , toured the physical plant areas inside and outside at 11:30 a.m to en sure there are no heal th and safety hazards and the facility is in compliance with Title 22 Regulations. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 4 (four) total bedrooms for resident use – 2 (two) are shared rooms and 2 (two) are private rooms. There is also 1 (one) staff room and 1 (one) office room. RESTROOMS: 2 restrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products in each restroom, as well as hand washing posters. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. The LPA observed the req uired postings in the common hallway. Fire extinguishers were observed to be serviced within the last year. Carbon monoxide and smoke detectors were observed to be in working condition at the time of visit. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. Laundry room was locked and contained storage cabinets for laundry supplies. The garage was observed locked and contained the emergency food supply, personal protective equipment and storage space. Continued on LIC -809 C KITCHEN : Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices at 12:15 p.m . T here is 1 entry into the facility. Upon entry, the facility has a central point for symptom screening. LPA noted that the facility is allowing visitors for both indoor and outdoor visitation. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. The following recommendations were made: - Post PINs and educate staff, residents, and families on changing policies and procedures from the Department During today's tour, LPA walked into an unlocked restroom that contained hydrogen peroxide, hyrocotizone, Norisc Cream and body lotion accessible to persons in care. Admin stated they will be locking the items and it will not happen again. LPA also walked into rooms that had bed rails. LPA reviewed resident files and it was revealed that 4 (four) out of 5 (five) residents did not have a bed rail order. Admin stated they have been a long time hospice resident and will contact the hospice agency to obtain the order. The following deficiencies were observed (See LIC 9099-D.) 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. 2 citations were issued during today’s visit. Exit interview conducted. A copy of the report with appeal rights was provided via email.