Facility Evaluation Report

On 10/27/2021 starting at 1:33pm, Licensing Program Analyst (LPA) C. Lin arrived unannounced to conduct Infection Control Inspection. LPA met with the Caregiver Erlinda Kloulubak and explained the purpose of the visit. Administrator Victoria Puruganan was unable to come to the facility due to family issue, and authorized Erlinda to assist with the inspection.

During the Infection Control Inspection, LPA toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and backyard. There is one central entry point for universal screening for staff, residents and visitors. Facility has a sufficient 2-day perishable and one-week non-perishable food supply. Facility has Mitigation Plan, Emergency Disaster Plan and maintains record of routine screening for residents, staff and visitors.

THE FOLLOWING DEFICIENCIES WERE OBSERVED:

· At 1:50PM, LPA observed unlocked centrally stored medications cabinet. Staff locked up the medication cabinet during inspection.

· At 1:52PM, LPA observed unlocked knives in a kitchen drawer. Staff locked up the knives to somewhere else during inspection.

· At 1:55PM, LPA observed unlocked cleaning supplies including bleach, all purposes orange and Raid in a kitchen cabinet. Staff locked up the cabinet during inspection.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiencies by POC date may result in additional Civil Penalties.

LPA spoke with Administrator who gave permission to staff sign and receive report. Exit interview conducted. Appeal Rights and a copy of this report provided.