Routine inspection·September 13, 2022

Licensing Program Analysts (LPA) Christine Wong conducted an annual required visit. LPA met with Administrator Leah Ignacio explained the reason for the visit and she also assisted LPA with the annual visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. The facility is a single story house located in the residential neighborhood. The facility consists four resident bedrooms, two bathrooms, live in staff room, kitchen, dining area, living room area, linen closet and a detached garage. All 4 resident bedroom were toured. Bedroom#1 and #2 has one bed, one drawer, one chair, required bed linen and furniture and sufficient lighting and closet space. Bedroom#3 and #4 has two beds, two drawers, required bed linen and furniture and sufficient lighting and closet space. Two bathrooms were toured and they are clean, sanitary and in a good working condition. The bathrooms have required grab bars and non-skid mats. The smoke detectors and carbon monoxide detectors are operational. The food supply both perishable and Non- perishable is adequate. Knives are locked in the pantry and inaccessible to residents. The living room and dining area are clean and have required furniture. No dangerous weapon and firearm. There is a shaded outside activity space available. Exits and passageways are free of obstructions. LPA reviewed 4 resident files to confirm emergency contact is updated. LPA also reviewed one staff file to confirm health screenings and fingerprint clearances. LPA reviewed 4 residents' medications and all the medications are centrally stored and the records are current. See LIC 809C for continuation. Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, social distancing, and the disinfecting products are available in each common area and facility is disinfected every night. The bathrooms have sufficient soap, paper towels, and signs, and PPE supplies are sufficient for more than 30 days. The deficiencies cited are documented on the attached 809D. A copy of the report and appeal rights will be provided to administrator Leah Ignacio.