Routine inspection·June 21, 2021

LPA Audrey Jeung toured facility and grounds. No accessible bodies of water or fire safety hazards are observed. There are 4 private bedrooms for residents and 2 common bathrooms. Infection control practices are reviewed: entry procedures, staff training and policies, resident monitoring, containment strategies, environmental preparation and cleaning. PPE supply is adequate and infection control signs are posted prominently. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Soap and paper towels are present in bathrooms and kitchen sink. 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 4 residents present, and 3 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Ruth Gripo is a certified RCFE administrator (x 4/22) that oversees facility operations The following forms/information are requested to be updated and submitted to LPA by 6/28/21: • LIC 308 Designation of Administrative Responsibility • LIC 309 Administrative Organization • LIC500 Personnel Report • LIC610 (revised) Emergency Disaster Plan • Proof of current liability insurance No deficiencies of the General Licensing Regulations, of the California Code of Regulations, Title 22, Division 6, are cited. See Technical Violations and Technical Assistance issued.