Routine inspection·July 6, 2022

Licensing Program Analyst (LPA) Delmundo conducted an unannounced annual/infection control inspection. LPA met with Lulin Wu, administrator, and informed the purpose of visit. LPA also met with Wendy Wong and Oilive Manalastas, licensees. Facility has an approved LIC808 Mitigation Plan on file. Administrator submitted the facility's new Infection Control Plan and received by LPA Delmundo on June 28, 2022. LPA toured the facility inside out with Lulin Wu. LPA inspected the living room, dining area, kitchen, hallways, side and backyard. LPA randomly selected 7 bedrooms for inspection. 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 Visitor's Log. Visitor's temperature and symptom checks are done at the entrance. Residents and staff are screened for COVID-19 symptoms, and temperature checked and recorded daily. Facility keeps record of proof of vaccination of residents and staff. Supplies of PPEs checked and observed adequate for 30 days, and antigen test kits are readily available. COVID-19 signages were observed throughout the facility. Trash bins were observed with foot pedal operated lids. Bathroom lavatories were observed with liquid soap and paper towels in dispensers. Some of the staff were fit tested for N95 respirator last year, Juiy 8, 2021. LPA verified, and Lulin stated some staff have been re-fit tested while others are scheduled for re-testing. Fire extinguishers checked and observed fully charge with tags showed serviced February 16, 2922. Hot water temperature in one of the common bathrooms was tested and measured at 106.6 degrees Fahrenheit. First aid kit inspected and observed complete with manual. . .....continued next page At 3:36 PM, LPA observed unlocked storage in the backyard where cleaning supplies are kept. The following updated/current documents were provided to LPA on this same day: 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 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 Olive Manalastas and Lulin Wu. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.