Routine inspection·June 22, 2021

Licensing Program Analyst (LPA) Joanne Roadilla conducted an unannounced Infection Control site visit today. LPA met with staff Minda Maynes. Administrator (ADM) Dominica Oliva arrived at the facility shortly. LPA toured the facility inside and out. Facility was observed to have a designated entry point for universal symptom screening including temperature check and a sign in sheet. Hand sanitizers were available by the screening station. Staff present were observed wearing a mask. All bathrooms were inspected and observed supplied with hygiene products and with hand washing signs posted. Bedrooms, kitchen, dining room, living room, and the outside grounds of the facility were inspected. All fire exit routes were clear of obstructions. Medications were observed locked. Facility also observed to have adequate supply of Personal Protective Equipment (PPEs). LPA reviewed the facility COVID-19 related infection control policies and procedures with ADM including screening, social distancing, surveillance testing, disinfecting, staffing, training, isolation, PPE use and inventory. Updated copies of the following documents were requested from ADM: 1. LIC 500, Personnel Summary 2. LIC 308, Designation of Administrative Responsibility 3. LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Current Administrator's Certificate. 5. A copy of Liability Insurance No deficiencies issued per Title 22 of the California Code of Regulations. LPA reviewed report with, and a copy provided to Dominica Oliva.