Routine inspection·November 30, 2021

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year Annual inspection, with an emphasis on Infection Control due to the COVID-19 pandemic. LPA Martinez met and was granted entry by Staff Soledad Larcia. Staff Larcia confirmed there are currently no cases or exposures of COVID-19 within the facility. LPA was screened upon entry into the facility. Licensee/Administrator Marites Villanueva Jarcia arrived shortly after. LPA observed the required Department posting on COVID-19 precautions at entrance of facility. There is a sign-in procedure in place and hand sanitizer for use. LPA observed that all staff were wearing face masks. The facility has an approved Mitigation Plan on file with CCLD. There were 5 residents present during this visit, 3 receiving Hospice Services. LPA conducted a tour of the facility and made observations pertaining to the facility's Infection Control measures. LPA toured all resident rooms, all rooms were within regulations. Residents were in their room and appeared relaxed. Restroom observed contained soap, toilet paper, paper towels, and had the proper hand washing signs posted. Facility has operating smoke and carbon monoxide detectors. Facility has Fire Extinguishers which was last charged on 09/04/2019. LPA observed a copy of Administrators Certificate which expires on 12/12/2021. The facility was equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Personal Protective Equipment (PPE) supply is available. The facility monitors the residents regularly for any COVID-19 symptoms/change of condition and documents. Facility has required Emergency Disaster Plan posted, and a secured location for resident's medication and files. Facility has 30 days supply of medications for the residents. Residents emergency contact information and Physicians reports are current. LPA reviewed resident files. Based on the observations made during the visit, the following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report, along with Appeals Rights, Confidential Names (Lic811), LIC9102 TA) was discussed with the Administrator and copies will be emailed.