Routine inspection·July 28, 2022

Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced on 07/28/2022 at 9:35 am 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 7/26/2023. The facility is licensed for 6 non-ambulatory residents, which 1 may be bedridden in room #1 only. There are currently 5 residents who reside at this facility. LPA toured the facility with administrator Aurora Gatchalian on 07/28/22 at 9:50 am. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry area, 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 to be 109.9 degrees Fahrenheit, which is within the required regulation of 105 to 120 degrees Fahrenheit. Facility thermostat observed at 74 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. Continued on 809-C The facility Mitigation Plan was submitted to CCLD, and it was approved on 3/28/2021. Infection Control Plan was submitted on 7/11/2022. 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. Annual fees has been paid on 7/27/22. The following forms and documents were requested to be submitted within 15 days: (1) LIC308 Designation of Administrative Responsibility (2) LIC500 Personnel Report (3) Copy of Administrator Certificate (4) LIC610 Emergency Disaster Plan (5) Proof of Current Liability Insurance Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. An exit interview was conducted and a copy of this report was provided