Routine inspection·August 8, 2022

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct annual/infection control annual inspection. LPA met with staff, Corazon Mariano and Warlita Romero. LPA called and spoke over the phone with Justino Balintona, licensee-administrator, and informed the purpose of visit. Justino arrived after several minutes. Facility has LIC808 Mitigation Plan on file. LPA started inspection with Warlita, and continued with Justino. LPA inspected the living room, dining area, kitchen, bed rooms, bathroom, 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 front entrance with visitor's log, hand sanitizer and no touch thermometer. Surgical masks and disposable gloves are readily available at the screening station. Visitor's temperature and symptom checks are done at the entrance. Staff are screened for COVID-19 symptoms and temperature is checked and recorded daily. Antigen test kits are readily available. COVID-19 signages were observed posted all throughout the facility. All trash bins were observed with touch free/foot pedal operated lids Supplies of PPEs were checked. All staff were fit tested for N95 respirators on July 23, 2021 . LPA discussed the requirement for yearly N95 fit testing Licensee stated he'll re-fit test the staff. ......continued next page Hot water temperature at the common bathroom was tested and measured at 114,7 degrees Fahrenheit. Fire extinguishers checked, observed fully charge and receipt showed purchased May 31, 2022. Smoke and carbon monoxide detectors were tested and observed operational. . At 12:50 pm, LPA observed bleach, Great Value All Purpose Cleaner with Bleach, Comet and ant & roach killer in unlocked kitchen cabinet. Licensee to submit the following updated documents by August 22, 2022: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan 4. Updated N95 fit testing record 5. Infection Control Plan 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. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.