Routine inspection·August 10, 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 Jhonna Pineda, Caregiver. LPA met with caregiver Pineda and discussed the purpose of today’s visit. A tour of the facility was conducted inside and out. LPA, accompanied by Caregiver Pineda 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 residents, staff and visitors; posted signs regarding visitor policy, promoting hand washing, cough and sneeze etiquette and other infection control procedures; Hand hygiene practices; testing plan and procedures; plans for containing infections; and disinfection procedures. Based on today’s inspection, no deficiencies were observed. An exit interview was conducted with caregiver Pineda. A copy of this report, along with the Licensee Rights (01/2016) was emailed to Aaron Lazarus, Licensee and caregiver Pineda at the conclusion of the visit. LPA requested licensee Lazarus to send LPA an electronic message reply confirming receipt of these documents. LPA requested licensee Lazarus to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500 and Emergency Disaster Plan LIC 610-E to the licensing office within 10 business days. Forms available at www.ccld.ca.gov .