Routine inspection·June 2, 2021

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted, temperature was checked, and was granted entry into the facility by Licensee Arlene Fajardo and explained the reason for the visit. During the visit LPA toured the facility. Facility is a 5 bedroom and 2 bathroom single story home. There are 5 Residents in care. LPA observed proper covid signage at front entrance of facility as well as sanitization and temperature check station. Facility has required Department postings. LPA observed copy of Administrators Certificate expiring June 18, 2021. LPA toured all Residents rooms, all rooms where within regulations. All restrooms observed contained soap, toilet paper and paper towels. Restrooms had proper hand washing signs posted. Residents were observed relaxing in the Living room watching TV. Facility has smoke detectors and audible alarms for each sliding door entrance/exit. Facility has 1 fire extinguishers which is out of code and last updated 01/16/2019. Facility has adequate supply of PPE. Facility has 2 refrigerators with ample food supply. LPA observed facility has emergency food and water supply. Facility water temperature was at 105.2 degrees F. Facility has required Emergency Disaster Plan posted. Facility has a secured location for resident medication and files. Based on the observations made during the visit, an immediate $500 civil penalty for Fire Clearance Violation cited per Title 22 of the California Code of Regulations. This report was discussed with the facility representative. An exit interview was conducted with Licensee Arlene Fajardo and a copy of report along with appeal rights was provided to facility.