Routine inspection·September 7, 2022

Licensing Program Analyst ( LPA) Ruth Wallace arrived at this facility unannounced to conduct a Required 1 Year Annual Licensing Inspection Visit. LPA was greeted by Licensee and LPA explained the purpose of the visit. LPA was screened upon entry for temperature and asked to sign in. LPA and Licensee inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is a 6-bed facility with a current census of 4. This facility has 3 bedrooms and 2 bathrooms as well as a formal living and dining room area. All knives, toxins, and other chemicals were inaccessible to residents in care. "See something, Say something" poster was in place. Resident rights and rights of resident council notices posted. Emergency disaster plan and facility sketch updated and posted. Administrator Certificate posted and expires 10/13/2023. Medications were locked and secured. The facility has submitted a COVID mitigation plan. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID-19 informational, and social distancing signs posted throughout the facility, on the front door, and back yard. The facility has a designated infection control lead. 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 108.2*F in the bathroom and room temperature reads 75*F. LPA observed the facility to have adequate food supply. 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. Facility has an emergency food and water kit. LPA reviewed two (2) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPA reviewed two (2) resident facility files and all documents were in files required by Community Care Licensing (CCL). Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held with Licensee and a report was left at facility.