Post-licensing visit·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 and paper towels--or cloth towels in private bathrooms--are available at all sinks. First-aid kit is inspected and complete. An updated Disaster and Mass Casualty Plan is readily available. There are 5 residents present, and 4 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Moddie Andaya and Billy Ick are certified RCFE administrators (x11/21 and x3/22 ) that oversee facility operations. The following updated forms are requested to be submitted to CCLD BY 5/26/21: • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report Proof of current liability insurance is given to LPA today. Mr. Andaya 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. Deficiency of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page.