Routine inspection·June 23, 2021

On the above date, Licensing Program Analyst (LPA) Christine Wong conducted an annual required visit. LPA met with staff Yanette Abzun and explained the reason for the visit and assisted with the tour of the facility. Shortly after, the house manager Stacy Lopez arrived. LPA used the infection control tool to evaluate the facility. LPA's observed the facility plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. Facility has submitted a mitigation plan and approved on 04/18/21. The facility is a single story house and located in the residential neighborhood. The house consists of 5 bedrooms, 2 bathrooms, kitchen, dining area and living room. Each bedroom has a smoke detector, bed, required linen, dresser, chair, sufficient light and closet space .All 2 bathrooms were toured. Bathrooms have the required grabs bars and non-skid mats. The hot water in the bathrooms and kitchen was measured between 117.9 to 119.3 degrees F. The food in the kitchen and storage room has sufficient supply of 2 days perishable and 7 days non-perishable. All the appliances are clean and working properly. The common areas such as living room and dining room are clean and have the required furniture. The back yard has a shaded area and sitting area. LPA's reviewed 5 resident files to confirm emergency contact is updated. LPA's also reviewed 4 staff files to confirm health screenings and fingerprint clearances. Staff#1 did not have a health screening on file and Staff#2 did not have TB test result on file. LPA's reviewed 5 residents' medications. Resident #4 (R4's) Lexapro 10 mg were not present at the facility. Staff indicated the medications had run out and will deliver today. The deficiencies cited are documented on the attached 809D. Exit interview conducted. A copy of the report and appeal rights will be provided to house manager Stacy Lopez.