Routine inspection·September 15, 2021

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA Quiroz was greeted and granted entry into the facility by House Manager (HM) HM Sara Dela Cruz and explained the reason for the visit. During visit, LPA Quiroz called and spoke to Administrator Gideon Limpiado who indicated Sara Dela Cruz would be the one present during today's inspection visit. This facility is licensed to provide services to residents age 60 and over, 6 Non Ambulatory Residents, of which 1 may be Bedridden. Administrator Gideon Limpiado has an active Administrator Certificate with expiration date of 4/22/2022. At 10:22AM, LPA Quiroz toured the facility with (HM) Dela Cruz . The Facility has currently 6 residents in care during today's visit. LPA Quiroz observed residents relaxing in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms had the required elements as well as restrooms stocked with soap/ sanitizer as well as hand washing. Facility HAS 4 single occupancy bedrooms, 1 shared bedroom for 2 occupants, 2 caregiver bedrooms and 2 bathrooms for staff, visitors and residents. The Facility screens all visitors to the facility. LPA Quiroz observed the screening/ sanitizing station in the facility upon entrance. The Facility utilizes a visitor sign in sheet. Facility takes resident temperatures daily and documents results. LPA Quiroz observed ample sanitizer spread out throughout the facility. Facility has COVID-19 precaution postings at facility entrance only. Facility mitigation plan has been submitted and pending approval. LPA Quiroz toured the outside grounds and observed the shaded outside visitation area. Exit gates are unlocked. LPA Quiroz observed the locked medication storage area. Facility has a plan for COVID-19 testing residents and staff as needed as well as a plan for isolation and quarantine. LPA Quiroz reviewed six of six resident files during the visit, two staff records and all contained updated emergency information. 5 of 6 residents and all staff are vaccinated for COVID-19. CONTINUED ON NEXT PAGE... During today's visit LPA Quiroz consulted with HM Dela Cruz and exit visit with Administrator Limpiado regarding the importance of following department recommended guidelines for COVID-19 precautions , visitation for residents, supply of emergency food and water and COVID-19 posting requirement throughout the facility. ( LIC 9102-Technical Assistance) During today's visit, no deficiencies were observed and the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with (HM) Dela Cruz and with AD Gideon Limpiado via telephone, and a copy of this report, LIC 9102, confidential names list were provided to (HM) Dela Cruz at exit.