Routine inspection·January 12, 2022

LPA Bruce Jacobs arrived at this facility unannounced to conduct an annual inspection visit. LPA was met by care staff who informed Administrator Allan Jose of the LPA's visit. LPA explained the purpose of the visit and Allan accompanied LPA on the facility inspection. LPA Jacobs inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility with a capacity of 6 and a current census of 5 with 4 client bedrooms and 2 client bathrooms. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. The hallway has COVID precautions in place including social distancing noted. Medications and toxins noted to be locked to residents in care. LPA also conducted the infection control domain tool. The facility common areas were clean and furnished. Smoke and carbon detectors were tested are are operational. Fire extinguishers were serviced in August 2021 and are in compliance. Facility has an emergency food and water supply in a separate storage area in kitchen. All staff on-site have current fingerprint clearances. Water temperature was measured at 128.5 degrees. The required range is 105 to 120 digress F. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2-days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. The facility submitted a LIC 808 mitigation plan , which was approved. 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 stations, COVID - 19 informational signage, and social distancing signs posted throughout the facility, on the front door, and outside. The facility has a designated infection control lead individual. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. LPA requested the following documents to be updated: LIC 500 and LIC 309 as needed. Per California Code of Regulations, Title 22 one deficiency was observed during this visit for the water temperature Exit interview was held and a report was given to Mr. Jose