Facility Evaluation Report

On 09/14/2021, Licensing Program Analysts (LPA) M. Yang and A. Walton arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPAs introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPAs met with caregiver Oscar Aninon and Margarita Viloria. Caregivers call Administrator Camalah Kopacz. LPAs conduct tour with caregivers. Camalah arrived later during tour. All five residents were present during the tour.

Facility tour conducted with Caregiver. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point.

Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. LPAs observed bathrooms did not have trash cans with lid. Hand washing posters were observed by the bathroom sink. LPAs observed residents bed to be at least 6 feet apart.

LPAs checked residents’ locked medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. LPAs did not observe 30-day PPE supplies. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. A sample of residents do not have updated emergency contact information.

A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit interview was conducted. A plan of correction was developed and reviewed with the administrator. Administrator was informed that as a COVID-19 precautionary measure, this report and appeal rights will be provided via email and an electronic read receipt confirms receiving this document.