Routine inspection·May 17, 2022

Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection. LPA arrived at facility, was greeted and granted entry by caregivers Monina and Roberto De La Cruz after explaining the purpose of the visit. Administrator Dina Lucaciu was notified and arrived later to assist with the visit. At approximately 1:45pm, LPA accompanied by Roberto De La Cruz toured the inside and outside of the facility. There are currently five (5) residents in care, one (1) of which is receiving hospice care. Residents are observed relaxing in their respective individual bedrooms and all appear clean and well taken care of. The bedrooms include all necessary components. The bathrooms are equipped with grab bars and slip mats. Hand washing signs are being displayed. Facility appears to be clean, sanitary and free of odors in all areas inspected. The smoke and carbon monoxide detectors present are observed to be functional. The fire extinguishers are charged and have been verified in March 2022. Sharp instruments are stored in a kitchen cabinet with a magnetic lock, as are cleaning supplies. Additional cleaning supplies are secured under lock in the attached garage. LPA observed the facility has COVID-19 Precautions posters and required department postings. Facility has an adequate supply of PPE. LIC808 Mitigation Plan has been submitted. Staff present is adequately associated in Guardian. Lysol and glass cleaning solution are observed to be stored under the sink in one of the resident's attached bathroom. CONTINUED IN FORM LIC809-C CONTINUED FROM FORM LIC809 LPA observed a sufficient supply of food and water. A 30-day supply of medication is centrally stored and locked in a cabinet. LPA toured the outside of the facility and observed it to be free of obstructions. The perimeter gates are self-latching and can easily be opened in an evacuation. No bodies of water are observed on the premises. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. A Technical Advisory is issued in regard to the storage of cleaning products. This report was reviewed with facility representative and a copy of this report was provided and left at facility.