Routine inspection·March 29, 2022

Licensing Program Analysts (LPAs) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection. LPA arrived at facility, was greeted and granted entry by Kiara Gordon, caregiver after explaining the purpose of the visit. Administrator Bahira Hanna was called via phone and was unavailable to assist the visit in person. At approximately 11:10am, LPA accompanied by caregiver toured the inside and outside of the facility. There is currently one (1) resident in care while a second one is currently at a Skilled Nursing Facility. The resident is observed to be relaxing in the living room and appears well taken care of. Three (3) of the six (6) bedrooms include all necessary components, while the three (3) others are equipped with every necessary items but beds. Bathrooms are equipped with grab bars and slip mats. Facility appears to be clean, sanitary and free of odors in all areas inspected. Sharp instruments are kept in a cabinet secured by a magnetic lock. Cleaning supplies and toxic substances are stored in the attached garage which has a combination lock on the door. However, cleaning supplies detergent, room deoodorizer, bug spray and other potentially toxic substances are found unsecured in multiple locations around the house, such as bathroom cabinets and the backyard. LPAs observed the facility has COVID-19 Precautions posters and required department postings. Caregiver indicates that the facility has no stored supply of PPE on the premises. A LIC808 Mitigation Plan has been submitted and approved by LPA Lyman on 05/04/2021. (CONTINUED IN FORM LIC809C) LPAs observed a sufficient supply of food and water. A 30-day supply of medication is centrally stored and locked in a cabinet. LPAs toured the outside of the facility. Outdoor furniture is present for the residents' enjoyment in the backyard. The perimeter gates are self-latching and can easily be opened in an evacuation. However LPA reminds caretaker that these gates marked on evacuation routes are required to be kept unlocked. Staff present is observed to be correctly associated in Guardian. The Administrator's license is up to date and posted in a central location. Based on the observations made during today’s visit, two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations and a Technical Advisory is being issued. This report was reviewed with facility representative and a copy of this report was provided and left at facility.