Routine inspection·October 21, 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 Licensee/Administrator Nicoleta Mogojan and explained the nature of the visit. Facility is licensed to provide service to six (6) Non Ambulatory residents and has a hospice waiver for (2) two residents. On or about 12:41pm, LPA Quiroz along with Licensee/Administrator Mogojan toured the inside and outside of the facility. There are (6) six residents in care and there are no active COVID-19 cases. LPA Quiroz observed one resident in living room area watching television and visiting with their family, one resident walking around facility and four residents in their bedrooms resting. All residents appeared to be clean and well taken care of. During today's visit, LPA Quiroz observed staff and visitors wearing masks due to COVID-19 precautionary measures. On or about 1:11pm, LPA Quiroz reviewed 6 of 6 resident records. 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. All bedrooms observed to have all required components. LPA Quiroz observed a check in station in the main entry of the facility. Facility is screening visitors upon entrance, and taking temperatures of residents daily and documenting results. LPA Quiroz observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water supply as well as PPE supplies. LPA Quiroz toured the outside of the facility and observed seating areas for resident’s enjoyment. Facility has completed the LIC808 Mitigation plan dated 4/01/2021 and LPA Quiroz approved the plan on today’s visit. CONTINUED ON NEXT PAGE... Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Licensee/Administrator Mogojan, and a copy of this report was provided to Licensee/Administrator Mogojan at exit.