Routine inspection·February 28, 2022

Licensing Program Analyst (LPA) Steve Chang conducted an annual inspection visit, and met with administrator (ADM) Wennice Concepcion. Upon arrival, staff Ana Guaco (S1) took LPA body temperature and checked LPA into the guest book. Screening station with thermometer, masks, hand sanitizer was observed at the main entrance. COVID posters 3923were observed at the main entrance and in facility. 3 residents were observed in facility. LPA toured the facility inside out with ADM. LPA inspected living room, kitchen, dinning area, and laundry room. Medication closet, knives closet, and cleaning product closet were observed locked. There are 3 resident rooms, three staff live-in rooms, and three restrooms in facility. Paper towels were observed without holders, ADM replaced all paper towels with holders. Cloth towels were observed in kitchen. ADM removed the cloth towel in kitchen. Trash cans were observed with covers. Washing hands signs were observed by the sinks in restrooms and kitchen. Room temperature was observed at 73 degree F, and hot water temperature was observed at 105 degree F. 2 days perishable food supplies and 7 days nonperishable food supplies were observed sufficient. PPE supplies were observed sufficient. The facility is equipped with smoke and carbon monoxide detectors. The facility equipped with fire alarm. ADM tested the smoke and carbon monoxide detectors, and they were working fine. LPA inspected the backyard, there was no obstruction to block the walkway. ADM stated all staff and residents are fully vaccinated and done with booster. No deficiency or issue noted during inspection. Exit interview was conducted with ADM. This report was provided to ADM for signature.