Routine inspection (multi-day)·September 29, 2021

Licensing Program Analyst (LPA) Fernandes-Goes conducted an unannounced Case Management - Annual Continuation Infection Control inspection to this facility and met with staff Catalina Sanchez & Renee Johnson. Facility has 4 residents present with 1 resident under Hospice care at this time. During facility tour on 9/29/2021 with staff Renee Johnson, facility was found to be clean and at a comfortable temperature. Bedroom 4 has a long hospital bed that per staff will be removed to allow residents to exit through the door if needed in case of emergency. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 9/2021. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. There was a supply of PPE available. Facility has a closet door and two window shades in the garage that facility will be installing on facility. Department is requesting submission of pictures showing that bed has been removed - smaller bed in place is OK, closet door and window shades installed by 10/6/2021. In addition, documentation below requested by 9/27/2021 still pending to be submitted to the Department: LIC 308 Designated Administrator LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 610E Supplemental Emergency Disaster Plan for RCFE LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Liability Insurance No deficiencies cited during this inspection.