Routine inspection·January 31, 2023

On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual required 1 year inspection visit focused on COVID infection control. LPA met with co-administrator Oscar Madirgal during today's visit and explained the purpose of today's Upon entry LPA was COVID screened and had temperature taken. LPA did observe COVID some signs posted a the exterior of the facility but LPA suggested to add more. LPA toured facility's building and grounds with Oscar. 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. Resident and staff daily temperature log is not current but facility has a policy in place to take temperatures of resident's who exhibit cold/flu symptoms. LPA advised on continuing the daily temperature check log of residents. Staff are screened via temperature check and COVID symptoms upon entry to facility. PPE supply is observed as in place in the assistant executive director's office. Medications, toxins and sharps are stored appropriately and inaccessible to clients. LPA discovered in the linen closet Comet and cleaning spray unlocked. Fire extinguishers are observed through out the facility as fully charged. Inspection date noted on a fire extinguisher adjacent to kitchen as inspected on 01/26/2023. Water temperature is tested at 130F in a resident bedroom in common hallway adjacent to a resident's room. Non-skid floor or non-skid shower mats are in place in resident room. Liquid soap is available and paper towels are available. Resident room adjacent to common bathroom is observed and they are equipped with the required furniture and light fixtures. First-aid kit is complete. A Disaster and Mass Casualty Plan is posted. Staff are observed wearing masks. Criminal record clearances or exemptions for facility staff or other individuals who have client contact is reviewed. Administrator certificate is current. All staff and residents are fully vaccinated and boosted. Continued on attached LIC809-C Page 2 - Required 1 Year Annual The following updated forms are requested to be submitted to CCLD by 02/07/2023 : • LIC 308 Designation of Facility Responsibility • LIC 500 Personnel Report • LIC 610E Emergency Disaster Plan • Copy of updated administrator certificate Citations are issued on attached LIC809D. Report is reviewed with administrator Oscar Madrigal.