Routine inspection·June 21, 2021

Licensing Program Analyst (LPA) Eva Torres conducted an unannounced infection control inspection. LPA met with Administrator Annie Allen. The purpose of today's visit is to inspect and ensure that the facility is following the California Code of Regulations, Title 22, Division 6. The facility is licensed for six (6) elderly non-ambulatory residents. The facility has a hospice waiver to serve three (3) residents. Tour included: Infection Control: LPA reviewed and discussed the Mitigation Plan with the administrator. LPA also provided consultation while reviewing the facility's training records, staffing plan, and screening protocols, including but not limited to inspecting their disinfectant supply and the use of personal protective equipment (PPE). Mrs. Allen was advised to remain updated on the changes and directions set forth by the department, so that their COVID’s policy reflects the current information on COVID’s guidelines. Physical Plant: front entrance, interior, and exterior surroundings were also observed to be clean with no pathway obstruction. The facility does not have firearms and or ammunition on the grounds. Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents. Records: The staff that LPA spoke with have a criminal background clearance in file and are associated to the facility. All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. The administrator certificate expires on 10/25/21. Based on today’s inspection, there were no deficiencies observed per Title 22 Regulation. LPA conducted an exit interview with the administrator. The Licensee Rights (LIC 9058 01/16) and a copy of this report with the administrator's signature on this form was emailed to them. A reply email or return receipt from the administrator will confirm receipt of documents.