Routine inspection·August 19, 2021

Licensing Program Analyst (LPA) Cynthia Chan conducted an unannounced annual required visit using the Infection Control domain. LPA met with Administrator, Samantha Alex, and explained the purpose of the visit. The facility is licensed for 6 ambulatory residents age 60 and over. There are currently 5 ambulatory residents at the home. LPA Chan toured the facility with the Administrator and inspected/observed the following: * There are 4 bedrooms and 3 bathrooms (3 bedrooms are for residents and 1 for the Administrator). Each bedroom is equipped with the required furniture. * There are 2 living rooms, a kitchen, and a spacious backyard with shaded area with a table and chairs. * Food supplies were observed for 2-day perishable and a week of non-perishable. * Some signs are posted regarding the Covid-19 (Coronavirus). * There are no items obstructing the entry or walkway. * Knives and disinfectants are inaccessible to residents. * Medication was reviewed for 3 residents and medications match the physician's orders. The following deficiencies were observed today: * The hot water temperature was measured at 134.2 degree F, which is over the required range of 105 – 120 degree F. * Staff #1 does not have fingerprint clearance nor associated to the facility. The deficiencies are documented on the LIC809D. An exit interview was conducted. A copy of this report, LIC809D, and the appeal rights were given to the Administrator.