Routine inspection·June 11, 2021

Licensing Program Analyst (LPA) Linda Almaraz conducted an annual required visit at the facility above. LPA met with Caregiver, Maria Pelky and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed residents' medications and observed food supply. Facility has submitted a mitigation plan and pending approval. The facility is a 4 bedroom, 3 bathroom (1 bathroom for staff/visitors) home located in a residential neighborhood. Facility has a main entry point for screening. All 6 residents bedrooms were toured. Each bedroom had required furniture and equipment. All bathrooms were toured and the toilets, hand washing and showers are safe and sanitary. Bathrooms had hand soap. The food in the kitchen was sufficient supply of 2 days perishable and 7 days non-perishable. The common areas such as living room and dining area are clean and have the required furniture. The backyard has a shaded area and sitting area. Medications are centrally stored, locked along with the records. Carbon monoxide and smoke alarm detectors were tested and working. Water temperature in both bathrooms were not within required range of 105-120 degree F. Bathroom #1 was reading at 129 degree F and bathroom #2 125 degree F. Deficiencies cited under California Code of Regulations Title 22 An exit Interview was conducted with the Administrator via telephone and a hardcopy was provided to the caregiver. Appeal rights were provided.