Routine inspection·June 7, 2022

Licensing Program Analyst (LPA) Christine Wong conducted an annual required visit. LPA met with caregiver Carmen Ortiz and explained the reason for the visit. Shortly after, the administrator/licensee Linda Morales and House Manager Stacy Santana Lopez arrived and assisted with the visit. LPA used the infection control tool to evaluate the facility. LPA 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 was approved on 04/18/2021. The facility is a single story house and located in the residential neighborhood. The facility included living room, dining room, kitchen, 5 bedrooms and 2 bathrooms. All 5 residents bedrooms were toured. Bedroom#1 to #4 has one bed, one drawer, one night stand and required bed linen, furniture and sufficient lighting and closet space. Bedroom#5 has two beds, one drawer, required bed linen and furniture and sufficient lighting and closet space. All two bathrooms were toured and they are clean, sanitary and in a operable condition. They also have required grab bars and non-skid mats. The hot water temperature in two bathrooms were measured between 113.9 and 117.6 degrees F which is within the Title 22 regulation. The refrigerator and kitchen cabinet in the storage room are sufficient for 2 days perishable and 7 days non-perishable food storage. All the appliance in the kitchen are working properly. The common area such as living room and dining room are clean and have the required furniture. The front and back yard are maintained well and the back yard has a shaded are and sitting area. LPA also inspected the carbon monoxide detectors and smoke detectors and they are located in each bedroom and common area and they are working well. LPA reviewed all 5 resident files to confirm emergency contact is updated. LPA also reviewed 3 staff files to confirm health screenings and fingerprint clearances and they are all fingerprint cleared and updated in the file. LPA reviewed all 5 residents' medications. R1's medication Lacosamide 100mg is not in the facility but listed on the Medication Administrative Record (MARs), R2's medication Alprazolan is in the facility but not on the MARs, R3's medication-Levothyroxine Sodium 75mg is not in the facility but listed on the MARs and R4's medication- Vitamin B-1 is in the facility but was not listed on MARs Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility,the facility is disinfected every shift. all bathrooms have sufficient soap, paper towels, and signs, the PPE supplies are sufficient for more than 30 days. 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 Santana Lopez.