Routine inspection·December 1, 2021

Licensing Program Analyst (LPA) Vasallo conducted an annual required visit. LPA met with caregiver, Queen Alimario and explained the reason for the visit. The Administrator was unavailable for the visit. LPA used the infection control tool to evaluate the facility. LPA inspected the physical plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. Facility has submitted a mitigation plan and the plan has been approved. All resident bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, and sufficient closet space. Both bathrooms were toured. Bathrooms have the required grabs bars and non-skid mats. The hot water was 116.2 degrees which is within the required 105 - 120 degrees. The kitchen was toured. All appliances were operating properly. There was a sufficient amount of perishable and non-perishable food. The common areas including the living room and dining room are clean and have the required furniture. There is a carbon monoxide detector in the hallway. The backyard has a shaded area and sitting area. The facility does not have any cameras inside or outside the home. LPA reviewed all resident files. Files were observed to be complete and had updated emergency contact information. LPA reviewed staff files. Files were complete including but not limited to first aid certificates, health screenings, proof of training, and proof of fingerprint clearance. LPA reviewed all residents' medications. Medications are documented properly and given as prescribed. At the time that LPA entered the facility, staff did not assess or take LPA's temperature. Also LPA was not required to sign-in. The assessment of visitors and sign-in policy are required per COVID-19 procedures and per approved mitigation plan. Per California Code of Regulations, Title 22, the deficiencies observed are documented on the attached 809D. Exit interview held. A copy of the report and appeal rights were provided to caregiver.