Routine inspection·June 28, 2021

LPA Audrey Jeung toured facility and grounds, consisting of 6 client bedrooms and a staff bedroom for one staff. 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. Liquid soap is available at all sinks. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 6 residents present, and 2 staff, plus the administrator. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Jennifer Tobias is a certified RCFE administrator (x 11/21) that oversees facility operations. The following updated forms/information are requested to be submitted to CCLD BY 7/6/21: • LIC 309 Administrative Organization • Proof of current Liability Insurance • LIC 808 Covid Mitigation Plan (updated with facility specific information) Updated Emergency Disaster Plan (LIC610E) and Personnel Report (LIC500) are given to LPA today. No deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are cited.