Routine inspection·March 17, 2022

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 and explained the reason for the visit. Administrator Tina Shalaby arrived during the visit. Administrator Shalaby has an administrator certificate that expired on 05/21/2021. At 9:00 AM, LPA toured the facility with Administrator Shalaby. Facility has 3 residents in care during today's visit with 1 resident on hospice care. LPA observed residents relaxing in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms had the required elements. Resident rooms are single and double occupancy. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the facility. Facility utilizes a hand written visitor sign in sheet. Facility takes resident temperatures daily and documents. LPA observed the first aid kit has all required items. Facility mitigation plan has been approved. LPA observed an ample supply of emergency food and water. At 9:20 AM, LPA observed unsecured cleaning items in an unlocked cabinet. LPA observed the shaded outside visitation area. Exit gates are self latching and unlocked. LPA observed the locked medication area. Facility utilizes a medication administration record. Facility provides activities in the form of exercise and music therapy. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. LPA reviewed all resident files during the visit and all files have updated emergency information as well as required documents. All residents and staff are vaccinated for Covid-19. LPA consulted with administrator on the importance of screening all visitors and ensuring all staff are wearing masks. Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.