Routine inspection·June 14, 2021

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required / infection control visit to the above facility. LPA was met by Cipriana Ancheta, Administrator and the purpose of today’s visit was explained. There are currently (6) residents in the facility . (3) residents are ambulatory and (2) are non-ambulatory. The facility is a single story structure located in a residential neighborhood. It consists (5) bedrooms, (2) full bathrooms, shaded back yard, front yard, laundry room in attached 2 car garage. LPA and Cipriana toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-4 are occupied by residents and contain the mandated furniture. Bedroom 5 is a staff bedroom. The (2) bathrooms are clean and operational. First aid kit is fully stocked with manual, smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. Residents Medications and file are current. Staff file is current. Ample supply of perishable and nonperishable food, hot water temperature is 120 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, 1 fire extinguisher is fully charged, fire drill conducted on 12/2021. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors are logged and temperature checked, and additional sanitation supplies are locked in a cabinet in room 4. LPA observed staff and residents wearing masks, isolation rooms are not needed, residents will be sent to hospital and required postings throughout the facility. The residents temperature's are checked and logged once a day. PPE's are enough for 30 days. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time. An exit interview conducted with Cipriana Ancheta, Administrator and copy of report provided