Facility Evaluation Report

On 9/14/2022 at 2:20PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct an Infection Control Inspection. LPA met with caregiver, Ofelia Calderon. Licensee, Merdith Castro arrived an hour later, but unable to stay to sign the report. Licensee gave authority to caregiver to sign CCLD reports.

Upon entry, staff did not conduct COVID-19 screening for LPA. LPA observed hand sanitizer at screening station. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common areas, and outdoor areas. LPA observed cough etiquette, signs & symptoms, and physical distancing are posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hand washing posters were posted at sinks and bathrooms.

During record review, LPA observed visitors log and temperature log for residents. LPA observed facility has a copy of Mitigation Plan on file. LPA observed food supplies and paper supplies are sufficient.

At 1:40PM, LPA observed deck gate is in disrepair, outside water faucet near the front door in disrepair, dried pine needles on deck/backyard, and side yard have furniture and other items that needs to be picked up.

At 2:00PM, LPA observed between bedroom 1 and bedroom 2 there was a door that was installed creating an additional resident bedroom. However, this new resident bedroom is a passageway to bedroom 1. LPA was informed by administrator and licensee that the door was installed early 2022 and no permit was obtained.

The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights was provided.