Routine inspection·February 3, 2022

Licensing Program Analyst (LPA) Vasallo conducted an annual required visit. LPA met with Administrator, Joel Villalva 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, observed food supply, and reviewed staff files. All resident bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, and sufficient closet space. Resident bathrooms were toured. Bathrooms have the required grabs bars and non-skid mat. The hot water was 109.1 degrees which is within the required 105 - 120 degrees. Cleaning supplies are inaccessible to residents. The kitchen was inspected. There is sufficient perishable and non-perishable food. All the appliances are cleaning and working properly. There is additional food in the refrigerator located in the garage. The common areas such as living room and dining room are clean and have the required furniture. The back yard has a shaded area and sitting area. Facility has emergency contacts for each resident and vaccine information. LPA confirmed staff working have fingerprint clearances. LPA reviewed 4 residents' medications, however the Medication Administration Record (MAR) was unavailable at the time of the visit. Also LPA could not verify health screenings for staff because the records were not available at the time of the visit. At the time of entry, staff did not conduct symptom screening for LPA nor was LPA required to sign-in. 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.