Routine inspection·August 1, 2022

Licensing Program Analyst (LPA) Delmundo conducted an unannounced infection control annual inspection. LPA met with staff, Leticia Iroy, and informed the purpose of LPA's visit. LPA also met with other staff, Dioscoro Iroy and Rudy Walter Soriano. LPA called Juliana Taburaza, administrato; no answer. LPA also called and sent text message to Sheilha Muniz who arrived after about fourty minutes. Facility has LIC808 Mitigation Plan on file. LPA received copy of Infection Control Plan submitted by Juliana Taburaza on June 30, 2022. Staff were fit tested for N95 respirators on August 24, 2021. Sheilha Muniz stated she'll have the staff retested; copies of certificates to be submitted by August 24, 2022. LPA toured the facility inside out with Leticia Iroy. LPA inspected the living room, dining area, kitchen, bedrooms, bathrooms, laundry area, side and backyard. There's adequate food supplies of perishables good for 2 days and non-perishables good for 7 days. LPA observed screening station located near the entrance with visitor's log, hand sanitizer and thermometer. Hand sanitizer, surgical masks and disposable gloves are readily available at the screening station. Temperature and symptoms check are done at entry for visitors and staff. Visitors are checked for proof of vaccination, and antigen test kits are readily available. Residents and staff are screened for COVID-19 symptoms and temperature is checked and recorded daily. COVID-19 signages were observed posted all throughout the facility. Supplies of PPEs were checked. Hot water temperature at one of the common bathrooms was tested and measured at 115.7 degrees Fahrenheit. Fire extinguishers checked and observed fully charge with tags showed serviced October 21, 2021. . ......continued next page At 2:41 pm, LPA observed Awesome all purpose degreaser and Comet in unlocked cabinet under the kitchen sink. LPA also observed two container of liquid laundry soap under the dining table. The following documents to be submitted August 15, 2021: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan 4. Proof of $3M liability insurance Deficiency is cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with Sheila Muniz. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.