Routine inspection·March 21, 2022

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met with caregiver Emelyn Bonifacio and explained the reason for the visit. Shortly after, the administrator Wilma Carstensen 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 pending for approval. The facility is a single story house and located in a residential neighborhood. The facility consists of four (4) residents bedrooms, two bathrooms, one live in staff room, kitchen, laundry area, staff office, dining room and a detached garage. The first and fourth residents bedrooms have two beds, two chairs, two drawers, and required linen and furniture and sufficient lighting and closet space. The second and third residents bedrooms have one bed, one chair, one drawer, required linen and furniture and sufficient lighting and closet space. The two residents bathrooms are clean and operational. The hot water temperature in the two bathrooms were measured at 116.9 and 118.8 degrees F. which are within the range of Title 22 regulations. The food supply in the kitchen and pantry has at least two days perishable and seven days non perishable food. The front and back yard are maintained well. The back yard has shaded area with tables and chairs for residents to use. The exit and passage way are free of obstruction. All the appliances are clean and working properly except the conventional oven but they do have a toaster oven for replacement. The common areas such as living room and dining room are clean and have the required furniture. The smoke detectors and carbon monoxide detectors are located in each residents bedrooms and common area and they are working properly. LPA reviewed 5 resident files to confirm emergency contact is updated. LPA also reviewed staff files to confirm health screenings and fingerprint clearances. Staff #2 (S2) did not have a health screening on file. LPA reviewed all 5 residents medication and all medications are accurate and updated. Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, disinfecting products are available in each resident room and bathroom and facility is disinfected every shift or as needed or every time resident finished eating, bathrooms have sufficient soap, paper towels, and washing hands signs, and PPE supplies are stored for more than 30 days. The following deficiency is cited under the California Code of Regulations Title 22 Division 6 Chapter 8 An exit interview is conducted, copy of the report and appeal rights given was provided to the administrator.