Routine inspection·September 10, 2021

Licensing Program Analysts (LPA) Christine Wong and Alberto Lopez conducted an annual required visit. LPA's met with staff William Castro and explained the reason for the visit. Shortly after, the administrator Leah Ignacio arrived and assisted with the visit. LPA's used the infection control tool to evaluate the facility. LPA's observed the facility plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. Facility has submitted a mitigation plan and was approved on 07/26/21 The facility is a single story house located in the residential neighborhood. The facility consists of three resident bedrooms, two bathrooms, staff break room, one live in staff room, kitchen, dining area, living room area, linen closet and detached garage. Each resident bedroom has two beds, two drawers, closet, night stand and sufficient lighting. Each bed has all required linen. Bathrooms have the required grabs bars and non-skid mats except bathroom#2, it was missing the grab bars in the shower. In addition, the toilet in the bathroom#2 was not working and it was clogged and waiting to be fixed. The hot water temperature measured at both bathrooms was between 114.6 and 116.1 degrees F. The smoke detectors and carbon monoxide detectors are operational. The food supply both perishable and non- perishable is adequate. Knives are locked and inaccessible. No dangerous weapon and firearm. There is a shaded outside activity space available . Exits and passageways are free of obstructions. LPA's reviewed 5 resident files to confirm emergency contact is updated. LPA's also reviewed two staff files to confirm health screenings and fingerprint clearances. Staff#1 (S1) was missing the health screening. LPA's reviewed 5 residents' medications and all the medications are centrally stored and the records are current. The deficiencies cited are documented on the attached 809D. A copy of the report and appeal rights will be provided to administrator Leah Ignacio.