Routine inspection·July 26, 2021

LPA Audrey Jeung toured facility and grounds of this split level home, consisting of 4 client bedrooms and a staff bedroom on the main level, plus 1 common bathroom and 2 private bathrooms. On the upper level, there are 2 client bedrooms and a common bathroom. On the lower level, there is a 1 car garage, an office and a staff room. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, staff training and policies, resident monitoring, containment strategies, environmental preparation and cleaning. PPE supply is adequate. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 2 residents present, and 2 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Alex Zitser is a certified RCFE administrator (x 6/21) that oversees facility operations. The following updated forms/information are requested to be submitted to CCLD BY 8/9/21: • LIC 308 Designation of Administrative Responsibility • LIC 309 Administrative Organization • LIC 500 Personnel Report • Current lease agreement • LIC 610E Emergency Disaster Plan (revised 9 pages) • Current liability insurance • In-service training requirements for staff • RCFE Medication training requirements for staff Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on a following page.