Routine inspection·June 1, 2021

Licensing Program Analyst Jose Villalobos conducted an unannounced Annual Inspection for Domain focused on Inspection Control. LPA was assisted by Administrator Lorraine Lopez The facility is licensed as a Residential Care Facility for Elderly. The facility is a single story home licensed for (6) residents (5) may be non-ambulatory and (1) may be bedridden and approved hospice waiver up to (4) residents. There are (6) total rooms and (3) total bathrooms. The facility was adequately furnished, including the dining room, activity room, outdoor shaded patio. LPA observed rooms #1-6. Each bedroom had the required, furniture, fixtures, equipment and supplies. Including complete set of bedding, linen supply, hygiene supply, storage space, lighting. The smoke detectors and the carbon monoxide detector were tested and are operational. LPA observed the facilities food supply. 30-Day supply of PPE's were observed. Medications, cleaning solutions, toxins, knives are locked and inaccessible to clients. First aid kit observed. Required posting for social distancing and infection prevention guidelines in place were observed. Body of water was inaccessible to residents and fenced in. Training on covid-19 infection prevention observed. Yard is free of debris. Exits and passageways are free of obstructions. Facility is following Covid-19 guidelines and recommendations. Mitigation plan was approved 5/14/2021. Files Reviewed: LPA Villalobos reviewed two (2) staff files and all had the following: Health screenings with TB information was also present. All staff files reviewed also had criminal record clearances and are associated to the facility. Two (2) staff files reviewed have current first aid certificates and proof of training on file. Health screenings with TB information was also present. Two (2) client Medication Charts was reviewed. There were no issues with medication observed. The last disaster drill was conducted on 4/21. The facility's annual fees are current and paid. No deficiencies were cited on todays visit using the Inspection Tool. Exit interview was conducted with Administrator Lorraine Lopez