Routine inspection·June 17, 2021

Licensing Program Analysts (LPAs) Karina Canela and Jill Nakagawa arrived unannounced to conduct an Annual Required inspection and met with Jessee Plenos, Licensee. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. LPAs signed the facility visitor sign-in sheet and Licensee took LPA's temperatures. LPAs discussed with Licensee to document COVID-19 screening questionnaire for visitors to the facility. Licensee stated staff and resident's temperatures are taken 2 to 3 times a day. The facility documents resident and staff's temperatures daily. LPAs conducted a walk-through of the facility with Licensee and observed COVID-19 precaution postings. Licensee stated staff clean and disinfect the facility twice a day. The facility has a visitation plan, provides virtual visits for medical needs, and phone calls for family to stay in contact with residents. All staff wore a face mask during this visit. LPAs observed a supply of PPE including gloves, N-95 respirators, and surgical masks. LPAs provided gowns to Licensee during today's visit. The facility has submitted a COVID-19 Mitigation Plan Report on Epidemic Outbreaks specific to COVID-19 to the California Department of Social Services for review. Facility staff to document and completed training on PPE use, isolation policies, and infection prevention. N-95 respirator Fit testing (Cal/OSHA requirement) is in process. Report continued on LIC809-C During the inspection, LPAs observed the following: Medications unlocked & accessible to residents in care: Resident (R1)'s refrigerated prescribed medication (Lactulose Sol, 473 ML bottle) observed unlocked and accessible within the facility kitchen refrigerator. 3 bottles (Tylenol, Aller-Tec, B-100 B-Complex vitamins), 1 tube of Triple Antibiotic & Pain Relief, and Suphedrine PE Nasal Decongestant Phenylephrine HCL Tablets belonging to R2 and observed in their bedroom (#4). 1 bottle of Advil,3 bottles of vitamins (Raw Vitamin C, Cal-Mag Citrate, Turmeric vitamin capsules) belonging to R3 and observed unlocked in their bedroom (#4). 1 tube of Diclofenac Sodium Topical Gel belonging to R4 and observed unlocked in their bedroom (#8). Licensee stated he would obtain a lock box for the inside of the refrigerator to lock refrigerated medication. Licensee stated he understood the regulation requirement. LPAs reviewed resident files. LPAs verified R1, R2, R3, and R5 (R4's roommate) Medical Physician Report (LIC 602) section #16 a. states the residents are not able to administer their own prescription medications. LPAs verified 5 of 8 residents are not able to administer their own prescription medications per their LIC 602. Toxins observed unlocked and accessible to residents in care: 1 gallon house paint can, 2 Gallons of Clorox, 2 bottles of Pinesol, 1 bottle of wood cleaner, and container of liquid insect killer repellant was observed unlocked and accessible in a closet located at the front entrance of the facility. Licensee stated it would be corrected immediately with a pad lock on the door. Fire Safety: 5 of 5 fire extinguishers located throughout the main hallway of the facility and kitchen area, was observed to be charged and last serviced 11/12/2018. Licensee stated the fire extinguishers are serviced yearly as required, however due to the 2020 COVID-19 Pandemic, the facility has been unable to have the fire extinguishers serviced. The facility will have the fire extinguishers serviced next week per licensee's statement. Report continued on LIC809-C... Locked food: Canned goods & Dry Foods stored in the kitchen walk-in pantry was observed to have a key padlock on the exterior to the pantry door. Licensee stated the facility locks the door leading to the kitchen/dining room and living room. Licensee stated the facility staff lock the pantry at night to guard against "contamination" by residents. LPAs explained the facility can not lock any food for residents as it is a personal rights violation. Licensee stated he understood the regulation requirement and stated he would not continue to lock any food. Appeal Rights Provided. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiencies and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Licensee Jessee Plenos, whose signature below confirms receipt of this report.