Routine inspection·August 5, 2021

Licensing Program Analyst’s (LPAs) Konnor Leitzell and Michael Hood arrived at the facility unannounced on 8/5/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPAs met with Adriana Stir (Administrator) and explained the purpose of the visit. Prior to initiating the annual inspection, LPAs completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted licensee and completed a facility risk assessment. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. Additionally, LPAs was screened by Adriana Stir and answers were documented in their visitor screening log. LPAs and Admin toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, four (4) of four (4) resident bedrooms, one (1) of one (1) staff room/office, three (3) of three (3) bathrooms, kitchen, garage, laundry room and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPAs and admin completed the infection control domain and facility was found to be in substantial compliance at this time. LPAs are requesting the following documents to be submitted to Community Care Licensing (CCL) by COB 8/13/2021 via email at konnor.leitzell@dss.ca.gov : Personnel Report (LIC500); Designation of Administrative Responsibility (LIC308); Affidavit Regarding Resident Cash Resources (LIC400); Surety Bond (LIC 402); Administrator certificate ; Partnership Agreement; Articles of Incorporation; Control of Property; Limited Liability Insurance; and Neighborhood Complaint Policy. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.