Routine inspection·July 29, 2021

On 07/29/21/ Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced annual inspection with an emphasis on inspection control. LPA was met by Facility Administrator Ki Hwan "Tony" Kim; and Stephanie Mangapit. The Purpose of the visit was explained. The Facility is Licensed to serve Individuals over ages 60 years and above. The capacity is for six (6) ambulatory clients, of which six (6) can also be non- ambulatory clients, and is approved for 6 hospice clients. Facility is a one story family home with six (6) bedrooms, one (1) staff break room, (6) full bathrooms, family room, living room, dining area, nook office area, kitchen, and garage. The one (1) car locked attached garage is located in the front of the property, and inaccessible to residents. The front yard, backyard and patios are in good condition. Walkways are free of hazards and debris. All Residents rooms have the required furniture. Beds have the required linen/supplies which include, pillowcase, fitted sheet, blanket and bedspreads, all rooms have required mattress pads. Ample supply of linen is stored in resident rooms. Cleaning supplies, and toxins are in the locked garage, only accessible to staff. The Hot water was tested and measured at 111.0 degree's which is within title 22 regulations. The facility last conducted a fire drill and had the fire department check hardwired smoke alarms in March of 2021. Both Administrators have valid Administrator certificates that expire on 12/04/ 21. The kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Resident and staff files were reviewed, and had required documentation's. LPA observed staff wearing masks, Visitor Log /Symptom screening Log, Designated isolation room, required Covid-19,Postings, 30 day supply of some PPE's and other required documents, including phone numbers are posting as mandated by the DPH and CCLD Technical advisory was given for the following areas: * 30 day supply of face shields * 30 Day supply of gowns * N95 Fit Testing Pins 21-12-ASC; 21-10-ASC; 21-09-ASC An exit interview was conducted a copy of this report was given. No citations were issued during this visit.