Routine inspection·December 10, 2024

On 12/10/24 at 12:30PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with administrator (ADM1) and explained the purpose of the visit. ADM has a current administrator certificate # 6024408740 which expires 01/25/2025. LPA toured the facility including but not limited to the front entrance, screening station, hand washing stations, kitchen, bathrooms, bedrooms and common areas. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand washing signs were observed posted in common areas. Facility has a 30-day supply of PPEs, paper, medications locked in medication room cabinets. Comfortable temperature was observed at 73 deg F per thermostat reading. Hot water temperature was measured at 111 deg F. Fire extinguishers were observed fully charged. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. LPA reviewed 5 staff and 5 resident files. The following deficiencies were observed during inspection: Absence of a screening station for COVID-19 symptom checks. Four (4) expired fire extinguishers re-inspection tags Emergency/Disaster quarterly fire drills documentation missing Continued on next page, LIC 809-C Updated copies of the following documents were obtained from administrator:  LIC500- Personnel Report  LIC9020 - Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties . Exit interview conducted. Appeal Rights and a copy of this report provided.