Facility Evaluation Report

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting an Annual Inspection. LPA met with Staff #1 (S1) Ida Calara and Administrator (AD) Buja Chang and discussed the purpose of the inspection. During the inspection, LPA and S1 conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following:

During the inspection, LPA observed there was 1 staff present, wearing PPE. LPA observed 1 resident was present. LPA confirmed all residents were doing well. LPA inspected common areas, resident rooms, garage, and kitchen. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA observed hallways and walkways were free of obstruction.

During the inspection, LPA and AD observed the following: staff supplements and medications accessible in the unlocked staff room with facility representatives unable to locate the key in the facility.

LPA reviewed and confirmed facility policies and practices regarding resident screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, staffing, infection control/lead/training, PPE, staffing and staffing shortages, and communication and emergency plan. LPA provided technical assistance regarding Guardian, Emergency Disaster Plan, N95 Fit Testing, and storage. LPA requested and reviewed resident roster, staff roster, resident files, staff files, emergency disaster plan, COVID-19 Mitigation Plan, and Infection Control Plan.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.