Routine inspection·September 29, 2021

On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted and granted entry into the facility by caregiver Pilar Biaco and explained the nature of the visit. Administrator Myrna Adriano arrived to facility at 12:56pm. This facility is licensed to provide services to 5 Non-Ambulatory Residents with one (1) bedridden , and has a hospice waiver for four (4) residents. Administrator (AD)Myrna Adriano has an Administrator Certificate with expiration date of 3/3/2023. On or about 12:27pm LPA Quiroz along with Caregiver Pilar Biaco toured the inside and outside of facility except garage area. Caregiver indicated "Only the Administrator has a key for garage." Two staff working at facility were observed to be wearing face masks upon arrival to facility. There are five residents in care and there are no active COVID-19 cases. During today's inspection visit, LPA Quiroz interacted with four of five residents in care. One of five residents in care was sleeping. Five of five residents appeared to be clean and well taken care of. LPA Quiroz observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer and appeared clean. LPA Quiroz inspected residents’ bedrooms and appeared clean and sanitary. LPA Quiroz observed a check in station in the main entry of the facility. However, upon LPA Quiroz entering facility, staff did not screen LPA Quiroz. LPA Quiroz requested to be screened and have temperature checked and recorded prior to entering facility . L/AD Adriano indicated "We were not recording visitors temperatures, but we will now." Facility is taking temperatures daily of residents and documenting results. LPA Quiroz observed the emergency disaster and evacuation plan. Facility has minimal emergency food, water supply and PPE supplies readily available. L/AD Adriano indicated "I will go out and purchase more." Between 1:00pm-1:26pm, LPA Quiroz toured the outside of the facility along with L/AD Adriano. Facility has completed the LIC 808 Mitigation plan, which was approved by LPA Micah Martinez on 3/10/2021. CONTINUED ON NEXT PAGE... During today's inspection visit, LPA Quiroz reviewed five of five resident records. Based on the observation made during today’s visit, the following deficiency (listed on the LIC809-D attached) was observed and are being cited per Title 22, Division 6, of the California Code of Regulations. This report was reviewed with Licensee/Administrator Myrna Adriano, deficienciynd appeal rights were discussed with Licensee/Administrator Adriano, and a copy of this report, LIC 809-D, Appeal rights and LIC 9102 Technical Assistance was provided to Licensee/Administrator Adriano at exit.