Routine inspection·January 27, 2022

At 12:25pm Licensing Program Analyst (LPA), Angela Panushkina, conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by the staff, Ma Victoria Fukuyama, who granted access to the facility and LPA explained the reason for the visit. LPA conducted physical tour and observed the following: Infection control: LPA reviewed the facility mitigation plan (approved on 02/16/2021) to make sure licensee was following current infection control recommendations. Upon arrival, LPA was screened and asked to sign-in the visitors’ log. In addition, LPA was asked all infection control questions. Proper signage was observed inside along the hallway and in the restrooms. Hand sanitizer was also observed. Ma Victoria stated they have sufficient PPE supplies for residents and staff. LPA observed all trash can throughout the facility have fitted lids. Kitchen: At approximately, 12:33pm LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The fire extinguisher is located by the kitchen area and was last serviced on 05/04/21. Smoke detectors/carbon monoxide . Dual smoke and carbon monoxide detectors were located throughout the facility, and at 1:15pm they were tested and observed to be operational. Bedrooms: There are six (6) bedrooms designated for residents use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational. Continue on LIC809-C Bathrooms: At 12:44pm LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 115°F. LPA observed appropriate grab bar and all showers had non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. All trash cans in bathrooms had fitted lids to protect from cross contamination. Common Areas : The facility maintains a comfortable temperature at 78°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Outside areas: At approximately, 12:40pm LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture for residents in care. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. Laundry: At 12:35pm LPA observed laundry area is kept locked and inaccessible to residents. Medications: At approximately, 12:35pm LPA observed medications are centrally stored and locked in the hallway cabinet and inaccessible to residents in care. Administrative: LPA collected Certificate of Liability Insurance, and LIC.500. No citations issued during this visit. Exit interview conducted. Copy of this report emailed to the Administrator.