Routine inspection·November 9, 2021

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced annual inspection visit with focus on infection control domain and a review of food and medication supplies. LPA Flores met with Marcelino Aguilar caregiver and explained the reason for the visit. Laura Aguilar administrator arrived 5 minutes later. The Facility is licensed to serve 6 non-ambulatory residents over the age of 60 and has an approved Hospice Waiver for six (6) residents. Facility is a single family home with 5 bedrooms, 3 bathrooms, a living room, dinning room, a kitchen, a front yard, a fenced back yard, a 5ft fenced pool, and a detached garage. Smoke/ Carbon monoxide detectors were tested and working. Facility has auditory devices on exit doors. LPA Flores tour the facility with Laura Aguilar and observed the following: Living room has a fireplace with a metal screen. 5 bedrooms were observed with all required furniture, sufficient lighting, and all required bedding items. LPA observed 3 bathrooms which had the required grab bars, and skid mats, water temperature was tested in bathroom #1 at 119.1; bathroom #2 at 119.5; and bathroom #3 at 115.2 which is within the required water temperature of 105 - 120 degrees F. Facility's kitchen was observed to have sufficient food supplies of at least 2 days of perishables and 7 days of non-perishables. Sharps and cleaning supplies were locked under the kitchen sink. Medication was observed locked in a cabinet by the kitchen, LPA reviewed medication for 3 residents. Administrator's certificate #6020261740 was reviewed for Luis Aguilar and expires in 9/23/22. Facility is following COVID 19 recommendations logs for visitors, staff, and residents screening were observed, signs are posted throughout the facility. Bathrooms have hand washing signs, soap, and paper towels available. Facility has a 30 day supply of medication. Facility's staff has an appointment to Fit Test for N95. Cleaning and disinfecting is done every 2 hours. No deficiencies were cited during this visit. Exit interview was conducted with Laura Aguilar Administrator and a copy of this report was provided.