Routine inspection·July 27, 2021

Licensing Program Analyst (LPA) Eva Torres conducted an unannounced infection control inspection. LPA met with House Manager Babette Gardner. 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) non-ambulatory elderly residents, in which one (1) out of the six (6) residents may be bedridden. The facility has a hospice waiver to serve four (4) residents. Tour included: Infection Control: LPA reviewed and discussed the Mitigation Plan with the House Manager. LPA also provided consultation on the facility's training records, staffing plan, and screening protocols. LPA also inspected the facility's disinfectant supply and the use of personal protective equipment (PPE). Mrs. Gardner was advised to remain updated on the changes and directions set forth by the department, so that their infection policy reflects the current information on COVID’s guidelines. Physical Plant: front entrance, interior, and exterior surroundings were observed to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance. The facility does not have firearms and or ammunition on the grounds. There was no body of water observed on the premises. 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: All staff present have a criminal record clearance in file and are associated with the facility. All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. The administrator certificate expires on 10/22/21. Based on today’s inspection, there were no deficiencies observed per Title 22 Regulation. LPA conducted an exit interview with the house manager. A copy of this report and the Licensee Rights (LIC 9058 01/16) was emailed to administrator, and their signature on this form confirms receipt of documents.