Routine inspection·July 9, 2021

Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced on 07/09/2021 at 1:50pm to conduct an annual inspection visit. LPA met with administrator Aurora Gatchalian and explained the purpose of the visit. Administrator holds current certification #6005801740 and expires on 7/26/2021. The facility is licensed for 6 non-ambulatory residents, which 1 may be bedridden in room #1 only. There are currently 6 residents of which 1 is bedridden. LPA toured the facility with administrator Aurora Gatchalian on 07/09/2021 at 2:10pm. LPA inspected the physical plant including but not limited to the common areas, kitchen, dining area, resident bedrooms; resident bathrooms, garage, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained and the hot water temperature was observed to be 110.8 degrees Fahrenheit. LPA observed there to be a sufficient amount of perishable and non-perishable food supply on hand. LPA observed knives and toxins to be locked away and inaccessible to residents. 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. Continued on 809-C The facility mitigation plan was submitted to CCLD, and it was approved on 3/28/2021. Facility has routine symptom screening checks for residents, staff, and visitors. The facility has a symptom check binder for staff, residents, 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 a copy of the following updated documents to Licensing Office with 15 days: (1) LIC 308 Designation of Administrative Responsibility; (2) LIC 500 Personnel Report; (3) Copy of Administrator Certificate; (4) LIC 610 Emergency Disaster Plan; (5) Proof of Current Liability Insurance Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview conducted and copy of report provided