Routine inspection·June 10, 2022

Licensing Program Analyst (LPA) Delmundo conducted an unannounced annual/infection control inspection. LPA met with Jonabelle Tolentino, administrator, and informed the purpose of visit. Facility has an approved LIC808 Mitigation Plan on file. LPA toured the facility inside out with Jonabelle Tolentino. LPA inspected the living room, dining area, kitchen, hallways, side and backyard. LPA randomly selected 9 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 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 were checked and observed adequate for 30 days, and antigen test kits are readily available. Staff were fit tested for N95 respirator, and copy of record was requested by LPA which LPA received on May 12, 2022. Fire extinguishers checked and observed fully charge with tags showed serviced January 19, 2022. Hot water temperature in one of the common bathrooms was tested and measured at 112.6 degrees Fahrenheit. . .....continued next page Administrator to submit copies of the following updated documents by June 24, 2022: 1. LIC308 Designation of Facility Responsibility 2, LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan 4. Proof of $3M liability insurance. LPA reminded that new Infection Control Plan should be submitted by June 30. 2022. No deficiency cited during today's visit. Exit interview conducted and copy of this report provided.