Routine inspection·December 9, 2021

Licensing Program Analyst (LPA) Vasallo conducted an annual required visit. LPA met with lead staff, Ralph Estanislao and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA inspected the physical plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. Facility has submitted a mitigation plan and the plan has been approved. All resident bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, and sufficient closet space. Both bathrooms were toured. Bathrooms have the required grabs bars and non-skid mats. The hot water was 111.4 degrees which is within the required 105 - 120 degrees. The kitchen was toured. All appliances were operating properly. There was a sufficient amount of perishable and non-perishable food. The common areas including the living room and dining room are clean and have the required furniture. There is a carbon monoxide detector in the hallway. The backyard has a shaded area and sitting area. There is a fish pond in the backyard that has a fence around the entire perimeter. The facility has cameras in the common areas. According to staff, the cameras are non-operational. LPA reviewed all resident files. Resident #1 (R1) and Resident #2 (R2) are diagnosed with dementia and have physician's reports that are older than one year. Dementia residents are required to have annual physician's reports. All residents had updated emergency contact information. Staff files were reviewed. Files were complete including but not limited to first aid certificates, health screenings, proof of training, and proof of fingerprint clearance. LPA reviewed all residents' medications. Medications are documented properly and given as prescribed. Per California Code of Regulations, Title 22, the deficiencies observed are documented on the attached 809D. Exit interview held. A copy of the report and appeal rights were provided.