Routine inspection·December 23, 2021

12/23/2021 12:30 p.m. Licensing Program Analyst (LPA) Nina Galarza conducted an unannounced site visit for the Required - 1 Year inspection. Upon arriving at the facility, LPA met with assistant administrator Elizabeth Martinez and stated the purpose of the visit. LPA later met with Administrator Lisa Pham and stated the purpose of the visit. LPA conducted inspection using Infection Control Domain Tool. The facility property is a two story commercial building, licensed to serve 80 non-ambulatory residents ages 60 and above, of which 10 can be bedridden. The designated rooms for bedridden residents are rooms 1, 3, 5, 7, and 9. The facility has an approved hospice waiver for 30 residents. There are a total of 40 resident rooms. The facility phone number is 562 379 9200. LPA toured facility with assistant administrator and S1. On the 1st floor LPA observed: medication room, conference room, 3 common restrooms, office, lounge/TV room, dining room(seating for 55), kitchen with pantry, outside patio area, janitor supply room and 20 resident bedrooms(including the one's designated for bedridden residents). On the 2nd floor LPA observed the laundry room, 4 common restrooms, activity room w/ break room, fitness room, telephone room, janitor supply room, and 20 resident bedrooms. LPA toured a random selection of resident rooms. Resident rooms were furnished appropriately. The bathrooms were observed to be clean and operational w/grab bars. The resident rooms have a signal system located by the resident bed. The signal system was tested in various locations and is operable. The hot water temperature was tested throughout the facility and met Title 22 Regulation guidelines. CONTINUED 809-C The kitchen, food supply and emergency food and water supply were observed. There was a sufficient amount of perishable and non-perishable food supplies. No pesticides or poisons were stored in the food areas. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA reviewed resident medications records and stored medication. All medications were properly labeled and administered as directed by the physician. The fire extinguishers were observed to be fully charged. Smoke/carbon monoxide detectors were observed to be fully operational. An outdoor shaded area is available in the outside patio area. There was no pool or bodies of standing water observed in the exterior of the facility property. Exits and passageways were free of obstructions. Per the California Code of Regulations, Title 22 no deficiencies observed. Exit interview held, copy of report and appeal rights provided.