Routine inspection·June 24, 2022

Licensing Program Analysts (LPA) Nune Margaryan conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Assistant Administrator Jose Bongay and explained the reason for the visit. Physical Plant was toured, residents files and medication records were reviewed, staffs files records reviewed and food supply was inspected. The facility is licensed for six (6) residents over the age of 60, with a hospice waiver for two (6) . The facility is a single story structure located in a residential neighborhood. It consists of the following: (3) resident bedrooms, (1) staff bedroom, (1) resident bathroom, (1) staff bathroom, kitchen, dining room, living room, laundry room, detached garage. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. LPA and Assistant Administrator toured the facility. All indoor and outdoor passageways were free of obstruction. There is only one entrance being utilized at the facility, all required posters were posted at the entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask during this visit. The kitchen was inspected. LPA observed all kitchen equipment to be clean and in working condition. LPA observed sufficient supply of perishable and non-perishable foods. Sharps, cleaning supplies are locked and inaccessible to residents. Smoke / Carbon monoxide detectors were in compliance and operational. There are (3) fire extinguisher located throughout the facility which are fully charged. The common areas (dining room, living room) appeared to be clean and were properly furnished. Resident rooms were sanitary and had the required furniture and furnishings. Medications are centrally stored in a locked cabinet in the kitchen. Continue 809C The bathrooms are clean and operational w/grab bars and non-skid surface/mats in place. The hot water temperature was tested and maintained within the required range of 105-120*F. LPA observed the centrally stored medication area to be locked and inaccessible to residents. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. LPA reviewed residents files to confirm emergency contact is updated. Residents medications reviewed. Medications documented properly and stored appropriately. LPA also reviewed staff files to confirm health screenings and fingerprint clearances. All staff files reviewed were fingerprint cleared . LPA provided a Technical Assistance LIC 9102 regarding N95 Fit testing for staff. Based on California Code of Regulations, Title 22, there were no deficiencies observed during the visit. Exit interview was conducted with Assistant Administrator Jose Bongay and a copy of this report and LIC 9102 was provided. .