Routine inspection·July 29, 2021

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 07/29/2021 at 9:11 AM. LPA met with Harue Seki 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. The facility is licensed for five non-ambulatory residents and 1 ambulatory resident. There are currently 6 residents who reside at this facility. The facility has a hospice waiver for 2 residents, which there are two residents receiving hospice services. LPA Martinez toured the facility with Harue Seki on 07/29/2021 at 9:20 AM. The facility is furnished and sanitary. The facility bathrooms are sanitary, and resident rooms are furnished and sanitary. The facility is equipped with utensils and dishware. The facility has a 2 day perishable and 7 day non-perishable food supply. The facility smoke/carbon detectors are in good repair. The exterior of the home is sanitary. The facility has a supply of linens and has a laundry area. Facility employee and resident files are complete. The facility has a first aid kit and first aid manual. LPA Martinez reviewed 2 medication files, which both files were up to date. The facility has one Covid-19 screening central point. The facility has Covid-19 postings throughout the facility. The facility has hand sanitizer throughout the facility. The facility has submitted a mitigation plan to CCLD. There were no deficiencies observed at this annual inspection. LPA Martinez conducted an exit interview with Harue Seki, and a copy of this report was given to Harue Seki.