Routine inspection·June 25, 2021

On 6/25/2021, Licensing Program Analyst (LPA) Leslie Ibo arrived unannounced to conduct an annual required inspection. LPA met with staff Michelle Valdez and informed the purpose of visit, while conducting facility tour, staff Alejandria Bautista and Administrator Romulo Bautista joined LPA the facility tour. Facility has census of 5. LPA toured the facility inside and out including but not limited to common areas, resident rooms, bathrooms, kitchen and backyard. Facility has enough supplies of paper , PPE and hygiene supplies. Medications are centrally stored in a locked area that is inaccessible to clients and refilled every at least 30 days. Facility has enough 2-day perishable food and one-week non-perishable food supply. There is one central entry point for universal screening for staff, residents and visitors. A thermometer and hand sanitizer were observed at screening station. Social distancing and hand washing posters were observed. Facility has a mitigation plan. ......Continued to LIC809C.... LPA observed the following: Routine symptom screening (+/- temperature and symptom check) has NOT been initiated at entry for all staff, residents, and visitors – facility was only checking for temperature and not all covid19 symptoms per interview and document review. Facility does NOT document daily temperature and COVID-19 symptom checks, and any change in condition for staff and residents – facility staff was only checking for temperature and not all covid19 symptoms per interview and document review. Signs are NOT posted throughout facility to promote , cough/sneeze etiquette, and other necessary covid19 posters – Facility has incomplete covid19 poster, LPA shared covid19 poster to Administrator to post at the facility. S1 was observed not wearing mask upon entry of LPA. Licensee/Administrator has NOT provided all staff fit testing for N95 respirators- Facility Administrator will schedule FIT testing for all staff, report needed to be sent to LPA, on or before 7/16/2021. Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with Administrator Romulo Bautista. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided