361800015-7-27-2021-18-AS-CCON-C5BT6B-20210727142652

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 361800015
Report Date: 07/27/2021
Date Signed: 07/27/2021 02:27:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	MOUNTAIN VIEW COTTAGES VII		FACILITY NUMBER:	361800015
ADMINISTRATOR:	JASBINDAR SINGH		FACILITY TYPE:	740
ADDRESS:	917 EAST MESA DRIVE		TELEPHONE:	(909) 608-0615
CITY:	RIALTO	STATE: CA	ZIP CODE:	92376
CAPACITY:	6	CENSUS: 5	DATE:	07/27/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Jasbindar Singh - Administrator		TIME COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced after completing a COVID-19 Risk Assessment Screening for the facility via phone call. LPA Colvin met with Administrator Jasbindar Singh and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Below is a summary of what was observed: Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with Administrator Jasbindar Singh, who LPA Colvin found to be successfully incorporating the several aspects of the facility's Mitigation Plan. Residents have hand sanitizer available to them, and the bathrooms were stocked with hand soap and paper towels, and there is a hand washing guide posted above the sink in the bathroom for residents to reference. LPA Colvin additionally observed the facility to have multiple postings throughout the facility for cough etiquette, proper hand washing procedure, social distancing, and emergency contact information. The facility's Personal Protective Equipment (PPE) supply is stored in the garage and staff room for easy access to staff. LPA Colvin confirmed that the facility has a 30-day supply of gloves, masks, and sanitizer, and isolation gowns. LPA Colvin went over the various recommended training for facility staff with Administrator Jasbindar Singh in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE. LPA Colvin inquired as to if staff have been fit tested for N95 masks, and Administrator Jasbindar Singh informed LPA Colvin that at this time staff have not been fit tested. LPA Colvin will be issuing a Technical Assistance Advisory Note during today's inspection for staff not being fit tested for N95 masks. LPA Colvin will not be issuing a deficiency for this item due to the facility not currently having any COVID-19 positive residents, and N95 masks only needing to be worn when a resident is COVID-19 positive or under observation while awaiting test results. Additionally, most residents have been vaccinated and are practicing other COVID-19 precautions, which minimize the risk of them contracting COVID-19.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MOUNTAIN VIEW COTTAGES VII	FACILITY NUMBER: 361800015
	VISIT DATE: 07/27/2021

NARRATIVE

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LPA Colvin will be providing Administrator Jasbindar Singh with the information for Provider Information Notice (PIN) PIN-21-10-ASC which contains resources for getting staff fit tested for N95 masks.

LPA Colvin inquired about if the facility is still conducting COVID-19 surveillance testing of their staff members. Administrator Jasbindar Singh informed LPA Colvin that they have not been testing their staff members anymore, however, the facility's vaccination rate is above 70%. On 6/7/21, Community Care Licensing (CCL) issued a new Provider Information Notice (PIN) with updated guidelines on surveillance testing of staff members for COVID-19. PIN 21-28-ASC states that if at least 70% of all staff and residents in a facility have been fully vaccinated and do not have any symptoms of COVID-19, then the facility is not required to continue to conduct surveillance testing. Since at least 70% of the facility is fully vaccinated, they are not required to continue to test their staff, unless they display symptoms or have close contact with someone who has tested positive for COVID-19. LPA Colvin additionally informed Administrator Jasbindar Singh of the new PIN (PIN 21-32-ASC) which came out today, and advised that as of 8/9/21, the new guidance for facilities will be to resume COVID-19 testing for staff, due to the increase of COVID-19 cases.

In addition to going over the facility's policy for testing staff and residents for COVID-19, LPA Colvin also inquired about if the facility is still screening their residents daily for COVID-19 symptoms, which includes checking their temperature. Administrator Jasbindar Singh confirmed that staff are continuing to monitor residents symptoms, and that both staff and visitors are screened for COVID-19 symptoms prior to entering the facility. LPA Colvin additionally observed a sign-in log for visitors, where their temperature is recorded as well as answers to screening questions.

An exit interview was conducted with Administrator Jasbindar Singh and a copy of this report and LIC9102 TA Advisory Note was provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

LIC809 (FAS) - (06/04)

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