Routine inspection·May 26, 2021

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Caregiver Julieta Cervania and explained the reason for the visit. Administrator Lester Del Rosario arrived during the visit. At 11:10 AM, LPA toured the facility with Caregiver Julieta Cervania . Facility has 6 residents in care during today's visit. LPA observed and spoke with residents in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All residents rooms had the required elements as well as restrooms stocked with soap/ sanitizer. Two rooms are single occupancy and two rooms are currently double occupancy. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the entrance of the facility. Facility utilizes a visitor sign in sheet. Facility takes resident temperatures daily and LPA observed temperature documentation. Facility has covid precaution postings as well as all required department postings. Facility submitted mitigation plan to the department. LPA observed the emergency disaster plan posted in facility. LPA observed emergency food and water as well as the first aid kit. LPA toured the outside grounds and observed the shaded outside visitation area. LPA observed the exit gate is padlocked. LPA observed the locked medication storage area. Facility has surgical masks, gloves, N95 masks as well as cleaning supplies. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation. All staff and residents are vaccinated for Covid-19. During the visit, LPA consulted with Licensee regarding the importance of maintaining a thirty day supply of all PPE as well as ensuring toxins are secured at all times.. Based on the observations made during the visit on 03/29/18, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided.