Routine inspection·October 20, 2022

On today’s date, Licensing Program Analysts (LPAs) LPA Rosie Quiroz and LPA Alvaro Ramirez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPAs were greeted, COVID-19 screened and granted entry into the facility by Caregiver 1. Administrator (AD) Marizonia Llorin and (L/AD) Joey Encarnacion arrived shortly after. LPAs explained the nature of the visit. This facility is licensed to provide services to residents age range 60 and over, 6 Non-Ambulatory Residents; of which (1) one may be bedridden in bedroom #4 only, and has a hospice waiver for six (6) residents. Facility is currently providing services to (6) six residents receiving hospice services. L/AD Joey Encarnacion has an Administrator Certificate with expiration date of 04/14/2024. On or about 9:37am, LPAs along with L/AD Joey Encarnacion toured the inside and outside of facility. There are six (6)residents in care and there are no active COVID-19 cases. During today's inspection visit, LPAs observed four (4) residents in dining-room area eating breakfast, (1) one resident in their bedroom watching television and (1) resident in the living room watching television. Six of six residents present in the facility appeared to be clean and well taken care of. LPAs observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer and appeared clean. LPAs inspected residents’ bedrooms and appeared clean and sanitary. All bedrooms observed to have all required components. Water temperatures in 2 of 2 bathrooms were recorded to be between 108.6-109.0 degrees Fahrenheit. Facility indoor temperature was recorded to be 78 degrees Fahrenheit. LPAs observed a check in station in the main entry of the facility. L/AD Encarnacion indicated facility is taking temperatures daily twice per day and documenting results. LPAs observed the emergency disaster and evacuation plan. Facility has back-up emergency food, water supply as well as PPE supplies. LPAs toured the outside of the facility and observed seating area with table and chairs for resident’s enjoyment in backyard area and front porch area. CONTINUED ON NEXT PAGE... CONTINUED... Facility has completed the LIC 808 Mitigation plan dated 2/18/2021. The LIC 808 Mitigation Plan was approved by LPA Quiroz on 11/4/2021. During today's inspection visit, L/AD Joey Encarnacion indicated "All residents and staff at facility are fully vaccinated for COVID-19, Boostered and awaiting scheduling for third booster." LPAs reviewed 6 of 6 resident's records during today's visit. During today's visit LPAs provided consultation on Infection Control, Title 22 and The Great California Shakeout earthquake preparedness drill taking place today at 10:20am. Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with L/AD Joey Encarnacion, and a copy of this report and LIC 811-Confidential Names were provided at exit.