Routine inspection·January 25, 2022

Licensing Program Analyst (LPA), Ruth Wallace conducted an unannounced 1 Year Required Inspection. LPA met with Administrator Lucia Boboc in the facility. LPA explained the purpose of the visit and was sanitized following the facility's entrance health and safety procedures. LPA also had her temperature checked and logged and then signed into the facility. Administrator Certificate #6033341740 Expires 12/17/2022. LPA conducted a tour of the facility with the Administrator. The physical plant is consistent with the submitted facility sketch/floor plan and has the COVID-19 health and safety signs. There are no obstructions blocking indoor and outdoor passageways. No pools or bodies of water observed. The facility's kitchen is free of debris. Food and water supply were observed as sufficient. LPA observed the facility's restrooms as clean and equipped with hand washing signs. The facility's backyard was free of debris. The residents' bedrooms were inspected and but two were private rooms with the required lighting and furniture. Facility was equipped with smoke detectors and carbon monoxide detectors. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 108.3 F degrees Fahrenheit in kitchen sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. LPA observed the fire extinguishers expire 6/10/2022. The facility's first aid kit included the required tweezers, scissors, and a thermometer. Cleaning solutions are stored and locked. PPE supply was sufficient. LPA reviewed facility procedures for visitation entrance, temperature checks and logs, COVID-19 isolation, PPE, food and cleaning supply storage. LPA observed centrally stored medications, toxins and sharp knives were locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed resident and staff files, including criminal record clearances. LPA observed all staff had Fingerprint clearance and as sociations to the facility. LPA reviewed three staff records for First Aid Certificates. First aid kit was checked and is complete. LPA requested the following documents to be submitted by February 8, 2022: Liability Insurance, Copy of Administrator Certificate, LIC 308 - Designation of Facility Responsibility, LIC 500 - Personnel Report, and LIC610E- Emergency Disaster Plan. Per California Code of Regulations, Title 22, no deficiencies were cited. Exit interview. Copy of report and appeal rights provided to administrator.