Routine inspection·August 4, 2022

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection on 08/02/2022. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyard of the facility to ensure compliance with Title 22 regulations. Administrator holds current certificate. The facility is licensed for five non-ambulatory residents and 1 bedridden resident. There are currently 5 residents who reside at this facility. There is one resident on hospice. The LPA toured the facility with Theresa Mata on 08/24/2021 at 8:50 AM. The facility is sanitary and clean, and the furniture is spaced 6 feet apart. The facility has a seven day food supply. Resident bedrooms are sanitary and furnished. The facility bathrooms are sanitary. The facility smoke detectors, carbon detector, and fire extinguisher are in good reair. LPA Martinez reviewed one resident file and one employee file. One resident file was complete. Staff 1's (S1) file did not have first aid/CPR training certificate. The exterior of the facility was clean and clear of debris. The emergency exterior gate is in good repair. The facility had required postings throughout the facility. The facility has a 30 day supply of PPE. The facility has one main screening entry point. The facility has covid-19 postings throughout the facility. Based on this annual visit, there was one deficiency. The deficiency can be found on the 809-D page. An exit interview was conducted, and a copy of this 809 report, 809-d page, appeals rights were given to the facility.