Routine inspection·January 27, 2023

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced required 1 year visit. LPA met with staff Raquel Salen and stated the purpose of the visit. LPA later met with Administrator, Elna Villaflor and stated the purpose of the visit. LPA conducted annual using the Infection Control Domain. LPA was screened upon entry. The facility is licensed to serve 6 non-ambulatory residents aged 60 and above. Hospice waiver for 1. The facility is a one story residential home with 5 bedrooms, 2 full bathrooms, living room, formal and informal dining room, kitchen, family room, laundry room, garage, front and back yards and a nook in kitchen area. The last fire/emergency drill was conducted on 12/28/2002. Administrator certificate expires 6/05/2024. OBSERVATIONS: · The interior and exterior physical plant was inspected. The facility is equipped with a fire pull alarm system. Smoke and carbon monoxide detectors were tested and operational. · COVID-19 Infection Control Practices and signs that promote hand washing, cough/sneeze etiquette, and physical distancing were observed in the entrance, common areas, hallways, bathrooms and client rooms. There is a screening station at the entrance of the facility to screen visitors. · Facility has designated a COVID-19 isolation room if needed. · A posted Emergency Disaster Plan was observed. · Centrally stored medications/30-day supply of medications were reviewed. · Staff were observed wearing mask. Clients do not wear masks be adhering to social distancing guidelines . · The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. · Water temperature was not within regulatory range. It measured 123.1 degrees in bathroom. · Facility has an adequate 30-day+ supply of Personal Protective Equipment (PPEs). · The facility submitted a COVID-19 Mitigation Plan. An Infection Control Plan (ICP) has been submitted. Deficiencies were cited. Please see 809D for details. Exit interview was conducted with Administrator, Elna Villaflor. A copy of the report was issued .