Routine inspection (multi-day)·July 29, 2021

Licensing Program Analyst (LPA) Nicol Wesley an unannounced Annual Continuation at the facility and met with staff Lydia Teofisto, Briana Schaefer, Proceso Dalina Gayda, and Eadgitha(Jody) Manalad and explained the purpose for todays visit. Prior to the visit LPA Wesley conducted a risk assessment for on-site inspections. The facility phone number is 562 868 1560. A Pre screening area with PPE supplies was observed upon entry into the facility. The mitigation plan was approved on 04/27/2021. During the visit Administrator Ronald Manalad arrived and joined the visit. The facility consist of four resident bedrooms(1 for staff), two bathrooms(1 for staff), living room, dining room, kitchen, den, back yard with covered patio and an unattached garage(storage and overflow of food). During todays visit, LPA attempted to access the Infection control tool, and it was not working. LPA Wesley contacted LPM Yee for assistance with the inspection tool domain, as well as contacted FAS specialist Paul Zoch who was not available at the time of visit. The facility has postings at the front entrance, bathrooms, and throughout the facility. Thermometer, visitation/sign in book, hand sanitizing gel and masks were located at the entry and throughout the facility. The facility was reminded to review and comply with PIN 21-28 ASC, in which effective 08/09/21 PIN 21-32-ASC will supersede PIN 21-28 ASC. LPA conducted a complete tour of the facility, and observe the supply of food, resident medications/medication logs were in compliance. The fire alarm system is hardwired, smoke detectors/carbon monoxide detector were tested and are operable. LPA observed one fire extinguisher in the kitchen area. The water temperature was tested and measured 108.6 degrees F. Administrators certificate for Evelina M Schaefer RCFE #6006565740 expires 11/10/2021 and Ronald R Manalad RCFE expires 09/10/2021. The following deficiency is being cited in accordance with California Code of Regulations, Title 22, Division (6) and Chapter (8) on the LIC 809D. a copy of this report, along with proof of corrections form(LIC 9098), and appeal rights were given during the exit interview.