Routine inspection·August 4, 2021

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 08/04/2021 at 1:09 PM. LPA met with Romona Dellroy and stated the purpose of today’s visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. Administrator holds a current certificate. The facility is licensed for 6 bed ridden residents, and has a hospice waiver for four . There are currently six residents who reside at this facility, which there are two residents receiving hospice services. The LPA toured the facility with the Romona Dellroy on 08/04/2021 at 1:15 PM. The facility has one central screening entry point. The facility has submitted a LIC 808 mitigation plan and has been approved. The facility has a designated area for visit. The facility has covid-19 postings. The facility has hand sanitizer throughout the facility. The facility common areas, bathrooms, and resident rooms are sanitary and furnished. The facility fire extinguishers are up to date. The exterior of the facility is sanitary and clear of debris. There were no deficiencies observed or cited at this annual inspection visit. An exit interview was conducted, and a copy of this 808 report was given to Romona Dellroy.