Routine inspection·June 11, 2021

Licensing Program Analyst (LPA) and Leslie Ibo arrived unannounced to conduct an annual required inspection. LPA met with staff Li Lingling and Jeanette Sumiran , and informed the purpose of visit, while conducting facility tour, Administrator Linda Kumihara joined LPA on facility tour. Facility has census of 3. LPA started the inspection with Jeanette continued with Linda . LPA toured the facility inside and out including but not limited to common areas, resident rooms, bathrooms, kitchen, backyard and side yard and garage. Facility do not have enough supplies of PPEs, but has sufficient paper supplies and hygiene supplies. Medications are centrally stored in a locked area that is inaccessible to clients and refilled every 30 days. Water temperature was tested in one of the bathrooms and measured at 105 degrees Fahrenheit. LPA observed the following; 1. "No Visitors Allowed" poster by the front door. 2. Facility do not have COVid19 posters around the facility and front door 3. Facility staff was not trained regarding proper Don/Doff of PPE (infection prevention measures) 4. Facility do not have enough PPE supplies (gowns & face shield) .....Continued to LIC809C.... Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with Linda Kumihara. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.