Routine inspection·March 1, 2022

Licensing Program Analysts (LPAs) Michael Hood and Talwinder Bains arrived at the facility unannounced on 3/1/2022 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPAs met with Administrator, Nicolasa Afable, and explained the purpose of the visit. Prior to initiating the annual inspection, LPAs completed required COVID-19 testing protocols, the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms, and contacted facility to complete a facility risk assessment. LPAs ensured to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask. LPAs toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to: 6 bedrooms and 3 bathrooms for residents, 1 staff bedroom, common area, dining room, food supply, PPE supply, storage, garage, medication closet, and outdoor area. LPAs and Administrator completed the infection control domain. Upon entry of the facility, LPAs observed that staff were not wearing face coverings while providing care to residents. During visit, LPAs observed backyard of facility contained debris, drawers containing knives were unlocked and accessible to residents in care, and food supply containing a large amount of expired food items, unlabeled and undated food items, and open food packages. As a result of today's inspection, deficiencies are cited pursuant to California Code of Regulations, Title 22, Section 80072(a)(2) regarding staff wearing face coverings while inside the facility, Section 87555(b)(8) regarding food supply, Section 87705 (f)(1) regarding accessible knives, and Section 87303(a) regarding debris in backyard. Deficiencies are listed on 809-D. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. The Administrator’s signature on these forms acknowledges receipt of these documents.