Routine inspection·March 8, 2022

Licensing Program Analyst (LPA) Nune Margaryan conducted an annual required visit. LPA met with Administrator Edelwina Calica who assisted with the visit. Reason for the visit was explained. LPA used the infection control tool to evaluate the facility. LPA inspected the physical plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. The facility is licensed for six (6) residents over the age of 60, with a hospice waiver for one (1) residents . There is only one entrance being utilized at the facility, all required posters were posted at the entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask upon entrance and during visit. LPA inspected the interior and the exterior of the facility with Administrator Edelwina Calica including but not limited to: living room, dinning room, kitchen, breakfast nook, laundry area in the back of the kitchen, three (3) resident bedrooms, two (2) bathrooms, covered deck, backyard and garage. All indoor and outdoor passageways are free of obstruction. No large body of water observed. Bathrooms and bedrooms were clean and in good repair. There is a locked storages for medications in the kitchen and toxins were locked in the garage. The kitchen was toured. All appliances were operating properly. There was a sufficient amount of perishable and non-perishable food. Kitchen knives and sharps are stored in a locked drawer in the kitchen. The common areas including the living room and dining room are clean and have the required furniture. Continue on 809C Residents bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, and sufficient closet space. Both bathrooms were toured and were observed to be clean, operational and equipped with grab bars and non-skid mats / materials. The hot water was 115.2 degrees which is within the required 105 - 120 degrees. All exit doors were alarmed and smoke detector was observed to be working properly. LPA observed 3 fire extinguishers throughout the facility which were fully charged. First-aid kit is complete and located in the living room. LPA reviewed residents files to confirm emergency contact is updated. LPA also reviewed staff files to confirm health screenings and fingerprint clearances. All staff files reviewed were fingerprint cleared. Residents' medications were reviewed. Medications are documented properly and stored appropriately. Based on California Code of Regulations, Title 22, there were no deficiencies observed during the visit. A copy of the report was provided to the Administrator.