Routine inspection·May 13, 2022

Licensing Program Analysts (LPAs) Nune Margaryan and Ya Ting Yang conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPAs met with Staff Martha Guzman 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 fifteen (15) residents over the age of 60 . The facility is a single story building. LPAs toured the home and inspected nine(9)resident bedrooms, two(2) staff rooms 3.5 bathrooms, kitchen, dining room, living room, office, storage room, and laundry room. There is only one entrance being utilized at the facility, all required posters were posted at the entrance. Screening area is located at the entrance of facility. Sign in sheet, hand sanitizer, gloves and masks are available. Staff conducted a routine symptom screening of LPAs at the time of entrance and have a sign-in policy as required per COVID-19 procedures. All staff were observed to be wearing mask during this visit. LPA observed that the facility does not have a swimming pool or other bodies of water. All indoor and outdoor passageways are free of obstruction. LPAs toured residents rooms. All bedrooms were furnished with required furniture. The bathrooms were observed to be clean, operational and equipped with grab bars and non-skid mats. The hot water was between 110.6 to 111.3 degrees which is within the required 105 - 120 degrees. The kitchen was inspected. There is sufficient perishable and non-perishable food. All the appliances are clean and seem to be operating properly. At the time of inspection LPAs observed chemicals and cleaning supplies under the sink and cooking knifes in drawer next to the stove unlocked and assessable to residents. Continue 809C LPAs 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. The facility has a sprinkler system with wired alarm. 3 fire extinguishers are present in the facility and are fully charged. LPAs observed the facility had the required carbon monoxide detectors. LPA reviewed 5 residents and 2 staff records. Residents' records were found to be complete and current. Staff files were reviewed, and documentation noted that facility staff maintain a criminal record clearance and associated to the facility. LPA randomly chose some residents' medications to review. Medications are documented properly and stored appropriately. Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Martha Guzman.