Routine inspection·October 11, 2021

On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted and granted entry into the facility by caregiver Consolacion Vallesteros and explained the nature of the visit. LPA Quiroz met with Caregiver Vivian Ortiz-Luis. During today's visit, LPA Quiroz called and spoke to Licensee/Administrator (L/AD) Geraldine Doan via telephone who also arrived shortly after. 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 and has a hospice waiver for six (6) residents. L/AD Geraldine Doan has an Administrator Certificate with expiration date of 09/27/2022. On or about 12:05pm LPA Quiroz along with Caregiver Ortiz-Luis toured the inside and outside of facility. Two staff working at facility were observed to be wearing face masks upon arrival to facility. There are five residents in care and there are no active COVID-19 cases. During today's inspection visit, LPA Quiroz observed three residents in dining-room area eating lunch in the dining-room, one resident watching television in living-room, and one resident in their bedroom resting. Five of five residents appeared to be clean and well taken care of. LPA Quiroz 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. LPA Quiroz inspected residents’ bedrooms and appeared clean and sanitary. All bedrooms observed to have all required components. LPA Quiroz observed a check in station in the main entry of the facility. Facility is taking temperatures daily and documenting results. LPA Quiroz observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water supply as well as PPE supplies. LPA Quiroz toured the outside of the facility and observed seating area with table and chairs for resident’s enjoyment. Facility has completed the LIC808 Mitigation plan, L/AD Doan will update and re submit updated LIC 808 Mitigation Plan to CCL by COB 10/12/2021. CONTINUED ON NEXT PAGE... During today's inspection visit, LPA Quiroz reviewed five of five resident records. L/AD Geraldine Doan indicated "all residents and staff at facility are fully vaccinated for COVID-19." 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 Geraldine Doan, and a copy of this report was provided at exit.