Routine inspection·June 3, 2021

Licensing Program Analyst (LPA) Bruce Jacobs arrived to conduct an unannounced Annual inspection on this date. Facility Administrator Antonio Arcal was informed of the purpose of the visit and was able to assist with the completion of the inspection focusing on the facility's mitigation plan and infection control procedures. The facility has submitted a written mitigation plan (LIC 808) and LPA obtained a copy of the Plan on this visit for review. Current Licensing guidance and infection control procedures discussed with Mr. Arcal. LPAs toured the facility and reviewed the Mitigation Plan as well as discussing Personnel Policies and Training during the Inspection. Smoke alarms and smoke detectors are hard wired to the facility, were tested and are in working condition Medication and toxins were locked and facility was determined to have an adequate food supply. Facility's PPE supplies were observed and determined to be adequate for a 30 supply. LPA provided the care home with additional PPE supplies including N95 and KN95 masks. The interior and outdoor area of the home was inspected including bedrooms, kitchen, bathrooms, and common areas for this home. There are five residents in the home and four resident bedrooms. LPA observed the following posted in the facility: Hand washing and visitation policies, See Something Say Something complaint poster, Reporting Requirements Resident Bill of rights, Resident Personal Rights, Evacuation Routes and facility license were all posted as required. Current LIC 500, LIC 308, and LIC 309 were requested to be submitted to Licensing within 30 days. Exit interview held with Mr. Arcal and a copy of report given at the conclusion of the visit.