Routine inspection·March 28, 2022

On March 28, 2022, at 11;45am, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. Upon arrival, LPA did not observe COVID signage posted at the front door. LPA met with Caregiver, Ligaya Munoz, and Administrator, Fereshteh Ehsanipour joined shortly thereafter. LPA Charitra explained the purpose of the visit. This is a single story facility with 6 resident bedrooms, 1 staff bedroom, 1 full bathroom and 5 half bathrooms. LPA toured the facility and grounds with the Administrator. No accessible bodies of water or fire safety hazards observed. Infection control practices are observed: entry procedures, screening log documentation for staff, visitors, and residents, and 30-day PPE supply. LPA observed the main bathroom and advised Administrator to put a hand-washing sign and to ensure the trash is covered with a lid. In addition, LPA advised Administrator to remove all hand-towels and to replace them with paper-towels. LPA observed all 6 resident rooms; 1 with a full bathroom and 5 with half baths. Resident's rooms were observed to be private rooms; 1 room is vacant at this time. LPA toured the kitchen and observed 2 day perishable and 7 day non-perishable present. Medications, toxins and sharps are stored appropriately and inaccessible to residents, and a comfortable temperature is maintained, lighting is sufficient for comfort. First aid kit was observed to be completed. LPA advised Administrator, to ensure hand-towels are not in the kitchen. LPA requests the following forms to be submitted to CCLD by 4/4/22: LIC308 Designation of Administrative Responsibility LIC500 Personnel Report Administrator Certificate LIC610E Emergency Disaster Plan No deficiencies were cited during the visit. LPA reviewed the report with caregiver, and a copy is provided.