Routine inspection·March 25, 2022

Licensing Program Analyst (LPA) Vasallo conducted an annual required visit. LPA met with caregiver, Jefren Maralit and explained the reason for the visit. Administrator was called and notified of the visit. LPA used the infection control tool to evaluate the facility. LPA observed the physical plant, COVID-19 procedures, reviewed residents' medications and records, observed food supply, and reviewed staff records. The facility cares for elderly residents and is approved for 3 hospice residents. There are currently 3 residents on hospice. All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, light, and sufficient closet space. The resident bathrooms have the required grabs bars and non-skid mat. The hot water was 106.6 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 clean and seem to be operating properly. The common areas include the living room and dining area. These areas are clean and have the required furniture. There is a screening station at the entrance of the home which has PPEs and a thermometer to screen visitors. Staff document resident temperatures daily and require visitors to sign in. Facility currently has at least a 30-day supply of PPEs. LPA reviewed 5 resident records to confirm emergency contact is updated and residents have health screenings on file. Resident #1 (R1) was admitted on 6/6/21 and did not have a physician's report on file. Resident #2 (R2) was admitted on 9/1/21 and did not have a physician's report on file. 2 staff records were reviewed to confirm health screenings, training and fingerprint clearances. LPA reviewed 5 residents' medications. Medications are documented properly and given as prescribed. Per California Code of Regulations, Title 22, the deficiencies observed during the visit are documented on the attached 9099D. Exit interview held. A copy of the report and appeal rights were provided.