Routine inspection·May 11, 2022

Licensing Program Analyst (LPA) Delmundo conducted an unannounced infection control annual inspection. LPA was granted entry by staff, Ernesto Cochico. LPA met with Soledad Escueta, assistant administrator, and informed the purpose of visit. LPA also met with other staff, Joana Tiglao. Facility has LIC808 Mitigation Plan on file. LPA toured the facility inside out with Soledad Escueta. LPA inspected the living room, dining area, kitchen, bathrooms, 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, surgical masks and no touch temperature probe. Visitor's temperature and symptom checks are done at entry and recorded. Residents and staff are screened for COVID-19 symptoms and temperature checked daily and recorded. Supplies of PPEs checked and observed adequate for 30 days for staff. All trash bins were observed with foot operated pedal lids. Antigen test kits are readily available. COVID-19 signages were posted in prominent areas in the facility. Fire extinguisher checked and observed fully charge with tag showed serviced March 31, 2022. First aid kit was observed complete with manual. Hot water temperature in one of the bathrooms tested and measured at 106.5 degrees Fahrenheit. Carbon monoxide and smoke detectors were operational. At 5:03 pm, LPA observed staff's medications and supplements stored in unlocked closet close to the dining area. .....continued on 809C Administrator to submit updated copies of the following documents by May 25, 2022: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan 4. Proof of $3M liability insurance Deficiency is cited per Title 22 California Code of Regulations on LIC809D. 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 Soledad Escueta. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction copy of this report provided.