Routine inspection·October 14, 2021

LPA Audrey Jeung toured facility and grounds of this 2-level home, consisting of 6 client bedrooms and a staff bedroom--each with a private half bathroom--on the main level, and a common bathroom, kitchen, living, and dining rooms. The upper level has 2 bedrooms, and is accessed from door within facility near rear door that exits to Alameda De Las Pulgas; it is occupied by tenant, and off limits to residents. There is a 2 car garage, where washer and dryer are located. 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. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 6 residents present, and 2 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Armand Atienza is a certified RCFE administrator (x 6/22) that oversees facility operations. The following updated forms/information are requested to be submitted to CCLD BY 10/28/21: • LIC 308 Designation of Administrative Responsibility • Current lease agreement for tenant • Current liability insurance • In-service training requirements for staff • RCFE Medication training requirements for staff Deficiency of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page. See Technical Advisory Notes for additional information.