Routine inspection·September 15, 2022

On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection-Infection Control visit. LPA Quiroz was greeted and granted entry into the facility by Licensee/Administrator (L/AD) Consolacion Lumauig and explained the nature of the visit. This facility is licensed to provide services to residents age range 60 and over, 6 Non-Ambulatory Residents and has a hospice waiver for four (4) residents. Facility is currently providing services to (2) two residents in care. L/AD Consolacion has an Administrator Certificate with expiration date of 08/08/2023. On or about 12:33pm LPA Quiroz along with (L/AD)Lumauig and Administrator Assistant Edison Sadraca toured the inside and outside of facility. There are five residents in care and there are no active COVID-19 cases at this time. During today's inspection visit, LPA Quiroz observed two (2) residents in dining-room/living room area, and three (3)residents observed resting in their bedrooms. Five of five residents appeared to be clean and well taken care of. LPA Quiroz observed 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. Facility is taking temperatures daily and documenting results. LPA Quiroz observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water in garage area and limited supply of PPE supplies. (SEE LIC 9102 TV) During today's visit, LPA Quiroz reviewed 5 of 5 resident records. Resident 5's physician report not available during today's visit (SEE LIC 809-D) LPA Quiroz along with (L/AD) Lumauig toured the outside of the facility and observed seating shaded area with table and chairs for resident’s enjoyment. Facility has completed the LIC 808 Mitigation plan and infection control plan. CONTINUED ON NEXT PAGE... During today's inspection visit, LPA Quiroz reviewed five of five resident records. (L/AD) Lumauig indicated 4 of 5 residents and staff are vaccinated and boostered. During today's visit, water temperature was recorded to be..... degrees Fahrenheit and indoor facility temperature was recorded to be between 77 degrees Fahrenheit. Based on the observation 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 (L/AD) Consolacion Lumauig, and a copy of this report and LIC 811-Confidential names, LIC 809-D and Appeal Rights were provided at exit.