Routine inspection·June 21, 2021

On 6/21/21 at 10:15 AM, Licensing Program Analyst (LPA) Suong Teh and LPA Christina Valerio arrived at this facility unannounced to conduct an annual inspection visit. LPA was met by support staff Helen Agniriogu ened upon entry for COVID precautions. LPAs explained the purpose of the visit to support staff. Administrator Emmanuel Dalia ed at 10:46 AM and met with LPAs. LPA explained the purpose of the visit to Administrator. Support staff Helen accompanied LPA on facility tour. LPAs inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 3. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. The hallway has COVID precautions in place including social distancing noted. Chemicals and medications were noted to not be accessible to residents in care. LPA also conducted the infection control domain tool. The facility submitted a LIC 808 mitigation plan , which is being reviewed. The facility has central entry point and has implemented screening and sign in procedures at the front door. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing stations throughout, COVID - 19 informational signage, and social distancing signs posted throughout the facility, on the front door, and outside. The facility has a designated infection control lead individual. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. Water temperature reads 122 F and the facility temperature registered at 77*F. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2-days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked July/2020. Facility has an emergency food and water supply in a separate storage area in kitchen. LPA requested the following documents to be updated: LIC 500, LIC 610E, LIC 308, LIC 309 and the lease agreement. Per California Code of Regulations, Title 22, deficiencies was observed during this visit. Exit interview was held and a report was given to Administrator Emmanuel Dalia.