Routine inspection·March 2, 2022

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on the infection control domain, food, and medication review. LPA Flores met with Syda Hai administrator and explained the reason for the visit. Facility is licensed to serve 6 residents, of which 5 can be non-ambulatory and 1 can be bedridden. Facility is in a residential neighborhood and is two stories home, first floor consist of a kitchen, living room, family room, 3 resident rooms, 2 bathrooms, 1 staff room, an attached garage. The Basement is the administrator's residential area and inaccessible to the residents. NO bodies of water were observed. Smoke detectors were tested and are in working condition. LPA Flores conducted a tour of the facility with Sayda Hai administrator and conducted a tour of the facility. Kitchen was observed, facility has sufficient food for at least 2 days worth of perishables and 7 days of non-perishables. Knives and cleaning supplies are kept under lock in the kitchen. Medication cabinet is located in the dining room and observed to be lock. LPA reviewed medication for resident #1(R1) and #2(R2). Each bedroom has sufficient lighting, furniture, and bedding supplies. Water temperature was tested in bathroom #1 and #2 at 105.0 degrees F. which is within the required 105-120 degrees F. Flies were reviewed for R1,R2, staff #1, and #2. LPA reviewed file for staff #2 which was missing health screening/TB test. Facility must update visitor's log to include screening questionnaire, and temperature log. Signs are posted in bathrooms and throughout the facility. PPE supplies were observed for at least 30 days. Staff have not been fit tested for N95 mask. Administrator Certificate was observed for Sayda Hai 6015618740 expiration date: 4/14/22. Deficiencies have been noted in LIC 809D per Title 22 Chapter 6 Division 8, and technical advisories have been noted. Exit interview was conducted with Sayda Hai and a copy of this report, LIC 809D, and appeal rights were provided.