Facility Evaluation Report

On 09/19/2022 at 2:00 pm, Licensing Program Analyst (LPA) C. Fowler arrived unannounced to conduct an Infection Control Inspection. LPA met with Caregiver, Annabelle Lacusong and explained the purpose of the visit. Administrator arrived at approximately 4:10pm.

Upon entry, LPA temperature were checked by staff. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common areas, and outdoor areas. LPA observed sign & symptoms, cough etiquette, and social distancing were posted in the common areas. Hand washing posters were posted at bathrooms and sinks.

During record review, LPA observed visitors log and temperature logs for residents and staff. LPA observed facility has a copy of Mitigation Plan on file.

The following deficiencies were observed during the visit:

-At 2:14pm, LPA observed unlocked scissors in office area.

-At 2:16pm LPA observed paint under the bathroom sink.

-At 2:18pm LPA observed WD-40, Bug & Tar remover.

-At 2:21pm, LPA observed 2 lighters unlocked in a kitchen drawer

-At 2:22pm, LPA observed unlocked cleaning supplies, Comet, 409 spray.

-At 2:28pm, LPA observed a ladder unlocked on the upstairs deck.

-At 2:29pm, LPA observed a bedframe, headboard, fax machine, recycling, dresser, chairs and night stand located in the backyard.

The 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.

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