Routine inspection·February 28, 2022

Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit for the purpose of conducting a required annual inspection visit. LPA arrived at facility, explained the purpose of the visit and was greeted by the caregiving staff and granted entry. Administrator Faith Rasouli arrived shortly after being called by the caregiving staff present. At approximately 3:00pm, LPA accompanied by Administrator began the tour of the facility. There are currently five (5) residents in care, including two (2) on hospice and one (1) currently at a Skilled Nursing Home after sustaining a fall. The residents are observed relaxing in their bedrooms and appear well taken care of. Facility appears to be clean, sanitary and free of odors in all areas inspected. LPA observed a check-in station right at the entrance of the facility where visitors temperature checks are being documented. LPA observed the facility has COVID-19 Precautions posters, all required department postings. Some hand washing signs are posted however some have gone missing in two bathrooms and will need to be replaced promptly. LPA observed a sufficient supply of food and water. Facility has an adequate supply of PPE stored in the attached garage. LPA toured the outside of the facility and observed outdoor seating for the residents' enjoyment. Outdoor space is free of debris and well-maintained with self-latching gates that can easily be opened on both sides of the house. All 6 individual bedrooms were observed to have all required components. Bathrooms are equipped with grab bars and slip mats. The facility has completed and submitted their LIC808 Mitigation Plan which has been approved by LPA Norman Woodridge on 07/26/2021. Based on the observations made during today’s visit, deficiencies are being cited today per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report and appeals rights was provided and left at facility.