Routine inspection·August 3, 2021

Licensing Program Analyst (LPA) Albert Marin conducted an unannounced required annual inspection in this facility. LPA met with Administrator (AD) Sal Diaz and stated the purpose of this visit. The facility is a single structure and licensed for 6 non-ambulatory and with hospice waiver for two. For this visit, there was no resident under hospice care. About 2:47 PM, LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. Facility had five residents in care and two staff members on the floor. LPA toured the interior and exterior portions of the facility. Currently there were one shared and three private rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair, provided with grab bars and nonskid floor mats. Hot water was measured at 111 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguisher was mounted and charged. For the exterior portion, facility had patio furniture in good repair, and grounds were free of tripping hazards. Facility had a pool enclosed by steel fence and rendered inaccessible to residents in care. Side exit doors were self-closing and self-latching. LPA reviewed the COVID 19 mitigation plan of the facility. For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations. LPA Marin conducted an exit interview with Administrator Sal Diaz; and copy of this report was left in the facility.