Routine inspection·February 20, 2023

Licensing Program Analyst (LPA) Delmundo conducted an unannounced annual/infection control inspection. LPA met with staff, Gerald Garcia and Marlyn Joaquin, and informed the purpose of visit. Josefina 'Josie' Booker, administrator, arrived after about 16 minutes followed by Leticia 'Lettie' Velasco, licensee/ Facility has LIC9282 Infection Control Plan and approved LIC808 Mitigation Plan. LPA started inspection with Gerald Garcia, and continued with Josefina Booker. LPA inspected the living room, dining area. family room, 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. Facility has Visitor's log. 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 throughout the facility. Bathroom lavatories were observed with liquid soap. Fire extinguisher checked, and observed fully charge with tag showed serviced July 28, 2022. Hot water temperature in the common bathroom was tested. LPA observed the following: 1. Hot water temperature at 134 degrees Fahrenheit. 2. Medications in all 4 residents rooms. .......continued on 809C 3. Cleaning supplies in unlocked garage and garage cabinets. 4. Door bell not working. 5. Rusted rake, bed frames, used bed, chicken wire. pieces of wood in the backyard. 6. Disposable face shields and gowns, and N95 respirators not sufficient for 30 days for 7 staff. License and/or administrator to submit the following by March 6, 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 Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with licensee and administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.