Routine inspection·April 14, 2022

Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced Annual required and infection control visit to the above facility. LPA was met by Carolyn Jacobs DSP , and later met with Antoinette Richardson Administrator , Senior the purpose of today’s visit was explained. There are currently (2) residents in the facility both residents are ambulatory. The facility is a single story structure located in a residential neighborhood. It consists (3) bedrooms, (1) full bathrooms, an umbrella provides shade in the back yard, front yard, laundry room and a detached 2 garage. LPA and Antoinette Richardson Administrator toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-3 are occupied by residents and contain the mandated furniture. The (1) bathroom is clean and operational. First aid kit is fully stocked with manual, smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. Residents Medications and file are current. Staff file is current. Ample supply of perishable and nonperishable food, hot water temperature is 116 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents 2 fire extinguisher is fully charged. First Aid kit complete and with Manual. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors are logged and temperature checked, sanitizer/soap in the bathroom and additional sanitation supplies are locked in the garage. LPA observed staff and residents wearing masks, resident private rooms will be converted to isolation rooms (if needed) and required postings throughout the facility. The resident’s temperatures are checked and logged once a day. PPE's are enough for 30 days. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time. An exit interview conducted with Antoinette Richardson Administrator and copy of report provided.