Routine inspection·April 7, 2022

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year inspection, with an emphasis on Infection Control due to the COVID-19 pandemic. LPA Martinez was granted entry into the facility by Administrator Ester DeLa Cruz and reason for the visit was explained. Administrator DeLa Cruz confirmed there are currently no cases or exposures of COVID-19 within the facility. LPA was screened upon entry into the facility. LPA did not observe the required Department postings on COVID-19 precautions at entrance of facility and/or throughout the facility. There was a sign-in procedure in place and hand sanitizer for use. LPA observed staff were wearing face masks. The facility has an approved Mitigation Plan on file with CCLD. Four residents were present. One Resident is receiving Hospice care. LPA conducted a tour of the facility and made observations: LPA toured resident rooms, all rooms were within regulations. Restrooms observed contained hand washing soap, toilet paper and paper towels. The proper hand washing signs were missing but were placed during visit. Facility has operating smoke and carbon monoxide detectors. Facility's Fire Extinguisher was charged. LPA observed a copy of Administrators Certificate which expired on 03/28/2023. 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. Staff and Residents files and medication are locked in a hallway cabinet. Facility has 30 days supply of medications for the residents. Observations made by LPA based on Physical Plant will be addressed at a later date. Based on observations made during today’s inspection focusing on Infection Control. no deficiencies will be cited per Title 22, Division 6, of the California Code of Regulations. LPA reviewed this report and LIC9102A with Administrators and a copy will be emailed.