Routine inspection·November 9, 2021

Licensing Program Analyst (LPA) Carmen Lopez made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself and was granted entry by Lucina Morgan, caregiver. LPA met with Licensee Marija Banovic and discussed the purpose of today’s visit. A tour of the facility was conducted inside and out. LPA, accompanied by Licensee Marija Banovic conducted a general overall inspection, with specific focus on infection control protocols. During today's inspection LPA observations include the following: Symptom screening procedures for staff, residents and visitors; posted signs regarding visitor policy, promoting hand washing, cough and sneeze etiquette and other infection control procedures; testing plan and procedures; plans for containing infections, PPE supplies procedures and training; and disinfection procedures. Based on today’s inspection, no deficiencies were observed. An exit interview was conducted with Licensee Banovic. A copy of this report, along with the Licensee Rights (01/2016) was emailed to Licensee Banovic at the conclusion of the visit. LPA requested Licensee Banovic to send LPA an electronic message reply confirming receipt of these documents. LPA requested Licensee to submit a current Personnel Report LIC 500 to the licensing office within 10 business days. Form is available at www.ccld.ca.gov . A current Designation of Administrative Responsibility LIC 308 and an Emergency Disaster Plan LIC 610-E were submitted to LPA Lopez during the inspection.