Routine inspection·May 19, 2021

LPA Audrey Jeung toured facility and grounds. 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. Soap, paper towels and signage of proper hand washing procedures is posted at all sinks. First-aid kit is inspected and complete. An updated Disaster and Mass Casualty Plan is readily available. There are 3 residents present, and 3 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Marietta Rubin is a certified RCFE administrator (x11/22) that oversees facility operations. The following updated forms/information are provided to LPA: • LIC 308 Designation of Administrative Responsibility • LIC 309 Administrative Organization • Proof of current Surety Bond • LIC 500 Personnel Report • Proof of current liability insurance Ms. Rubin is advised that Personal Rights form (LIC613C-2) has been revised to include Health and Safety Code 1569.269, non-discrimination (LGBTQ) notice, AND Centralized Complaint and Information Bureau (CCIB) contact information. This information must be posted prominently in facility, and LIC613C-2 must be signed by resident or his/her representative. No deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed. Facility is operating in substantial compliance.