Routine inspection·March 3, 2022

On 3/3/2022 at 9:40 AM, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection visit. Prior to entering the facility, LPA Truong called and spoke to staff, who confirmed no residents or staff have had any symptoms of COVID-19 in the last 10 days. LPA met with Administrator Daniel Tafta and explained the purpose of the visit. Administrator holds current certification #6043996740 and expires on 2/13/2023. The facility is licensed for six (6) non-ambulatory residents and has hospice waiver for three (3). There are currently three (3) residents of which two (2) are on hospice. LPA toured the facility with administrator Daniel Tafta on 3/3/2022 at 9:55 AM. LPA inspected the physical plant including but not limited to the common area, kitchen, pantry, dining area, resident bedrooms, resident bathrooms, laundry room, garage and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. The hot water temperature was observed in bathroom and kitchen and were within the required regulation of 105 to 120 degrees Fahrenheit. Facility thermostat observed at 73 degrees Fahrenheit. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed knives and toxins to be locked away and inaccessible to clients. Smoke and carbon detectors were in good repair. Fire extinguisher and first aid kit was up to date. LPA checked medication storage and found medication to be locked away and inaccessible to clients. LPA also conducted the infection control domain tool. Report continued on 809-C The facility mitigation plan was submitted to CCLD, and it was approved on 2/21/2021. Facility has routine symptom screening checks for clients, staff, and visitors. The facility has a symptom check binder for staff, clients, and care staff. Hand Hygiene procedures have been implemented. Facility had Covid-19 posters throughout the facility, and the facility has implemented Covid-19 mitigation plan. Administrator was informed to send updated copies of the following documents to CCL within 15 days: (1) LIC308 Designation of Administrative Responsibility (2) LIC500 Personnel Report (3) LIC610 Emergency Disaster Plan (4) Proof of Current Liability Insurance (5) Copy of Administrator Certificate Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was conducted and a copy of this report was provided.