Routine inspection·September 9, 2021

Licensing Program Analyst (LPA), Farhaan Sarangi arrived at Haven Hosue of San Rafael for the purpose of conducting a Unannounced Required 1 year inspection. LPA was met at the door by Caregiver, Elvira Gazal and granted access into the facility. LPA toured the facility with Caregiver, Elvira Gazal. Facility is a one floor building. The facility was inspected and found to be cleaned and at in good repair. Exits were equipped with auditory devices and delay egress that were found to be operational and on during the inspection. Fire Extinguisher was found to be last charged on 12/2020 at the time of the visit. Smoke detectors and carbon monoxide detector were found to be working at this time. Hot water temperature checked 110.4 degrees F. The facility has a phone line designated for residents use. There was an ample supply of personal hygiene products, bedding and linens, utensils, dishes, and cook ware as per observation. There were emergency supplies available at the time of the visit. Facility had ample supply of perishable and non-perishable foods. Toxins and hazardous items were locked and inaccessible to residents in care. First Aid kit was found to be appropriate during the time of the inspection. Facility understands that all beds should be outfitted with mattress pads as per Title 22 Regulations # 87307. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has PPE. Facility is N95 Fit tested. No deficiencies were observed or cited during today's Required 1- Year inspection. Exit interview was conducted and a copy of this report was emailed to the facility Caregiver, Elvira Gazal.