Routine inspection·September 20, 2021

On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted and granted entry into the facility by caregiver Conrado Caniga and explained the nature of the visit. Licensee/Administrator Almiranez arrived shortly after. This facility is licensed to provide services to age range 60 and over, approved for 6 Non Ambulatory Residents, of which 1 may be bedridden, and has a hospice waiver for four (4) residents. Licensee/Administrator has an active Administrator Certificate with expiration date of 04/10/2022. On or about 9:06am, LPA Quiroz along with Caregiver Caniga toured the inside and outside of facility. On or about 9:32am, LPA Quiroz toured the inside and outside of the facility with Licensee/Administrator Almiranez. There are five residents in care and there are no active COVID-19 cases. LPA Quiroz observed one resident in living-room area resting, and four residents in their bedrooms resting. All residents appeared to be clean and well taken care of. LPA Quiroz observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer. LPA Quiroz inspected residents’ bedrooms and appeared clean and sanitary. All bedrooms observed to have all required components. LPA Quiroz observed a check in station in the main entry of the facility. 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 supply as well as PPE supplies. LPA Quiroz toured the outside of the facility and observed seating area For resident’s enjoyment. Facility has completed the LIC808 Mitigation plan, which was approved by LPA Kimberly Lyman on 8/24/2021. CONTINUED ON NEXT PAGE... Based on the observation made during today’s visit, the following deficiencies (listed on the LIC809-D attached) were observed and are being cited per Title 22, Division 6, of the California Code of Regulations. This report was reviewed with Licensee/Administrator Almiranez, deficiencies and appeal rights were discussed with Licensee/Administrator Almiranez, and a copy of this report, LIC 809-D, Appeal rights and LIC 9102 Technical Assistance was provided to Licensee/Administrator Almiranez at exit.