Routine inspection·February 26, 2023

Licensing Program Analyst (LPA) Delmundo conducted an unannounced annual/infection control inspection. LPA met with staff, Josefino 'Budoy' Joshue and Rosalita Llegado, and informed the purpose of visit. LPA called and spoke with Juliana Taburaza, administrator, over the phone who authorized Josefino Joshue to be with LPA during inspection, and sign and receive this report. Facility has an approved LIC808 Mitigation Plan. Administrator submitted the facility's Infection Control Plan which LPA received on June 30, 2022. LPA toured the facility inside out. LPA inspected the living room, dining area. kitchen, hallways, residents bedrooms, 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 by the front entrance with hand sanitizer, no touch temperature probe and N95 respirators. Facility has Visitor's log. Temperature and symptom checks are done at the entrance. Facility keeps record of proof of vaccination of residents and staff. Supplies of PPEs checked. Facility has antigen test kits readily available. COVID-19 signages were observed in some areas of the facility. . Bathroom lavatories were observed with liquid soap and hand dryer. Fire extinguishers checked, and observed fully charge with tags showed serviced October 18, 2022. Hot water temperature was tested in the one of the common bathrooms .......continued on 809C LPA observed the following: 1. Trash can in one of the bathrooms with no lid. 2. No "Wear Mask" posters on the front entrance door and living room. 3. Disposable gowns not sufficient for 30 days for 8 staff. 4. Hot water temperature at 100 degrees Fahrenheit. Administrator to submit the following by March 12, 2023: 1. LIC308 Designation of Facility Responsibility 2, LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. Proof of $3M liability insurance. 5. Current N95 fit testing records/certificates Deficiency is cited from Title 22 California Code of Regulations, and listed on 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 administrator over the phone. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.