Facility Evaluation Report

On 06/22/2022 at 2:55 pm, Licensing Program Analyst (LPA) C. Fowler arrived unannounced to conduct an Infection Control Inspection. LPA met with Caregiver Elizabeth Valencia, and explained the purpose of the visit. The Administrator Konah Dolo arrived at approximately 3:30pm.

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. LPA observed PPE and paper supplies are sufficient.

The following deficiencies were observed during the visit:

-At 3:22pm, LPA observed a broken lock on the cabinet under the sink located in the kitchen.

-At 3:24pm LPA observed a broken lock on a drawer with knifes and scissors.

-At 3:27pm LPA observed medication in a unlocked drawer located in the kitchen.

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.