Routine inspection·October 5, 2021

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Administrator Liana Vertelkina and explained the purpose of today's visit. This is an RCFE with a capacity of 21. The facility is licensed to serve 21 ambulatory residents, ages 60 years and over . The following was inspected and toured: 19 resident bedrooms which consist of 18 single and 1 shared room, each bedroom has a sink and toilet. There is a recreation room, Kitchen, Dining hall, laundry room, medication room, 3 storage rooms, 3 baths and 1 shower, Office, Staff restroom and visitor restroom and outside shaded patio. The following were observed/inspected: COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility, and in all common rooms and hallways. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Residents are able to use their private accommodations as isolation rooms if they have private rooms and if residents have shared rooms there are designated rooms to be used as isolation rooms if a COVID-19 positive case should arise. 30 day supply of medication reviewed for (6) residents (Resident #1 through Resident #6) Facility has an adequate amount of PPE and facility has enough PPE for 90+ days. Residents were socially distanced according to local public health guidelines. Residents wearing masks. Staff responsible for direct care and supervision were observed wearing masks. Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed (including paper goods, utensils etc). According to the California Code of Regulations, LPA did not observe any deficiencies, therefore no citations were issued at this time. An exit interview conducted with Administrator Liana Vertelkina 5and copy of report provided.