Routine inspection·October 22, 2021

At 12:40PM, Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Annual Inspection, and met with house manager Desena Jacaban (HM). Upon arrival, caregiver Julie Salazar (JS) took LPA's body temperature, and checked LPA in the visitor log book. The central screening station was observed at the main entrance. LPA observed the COVID posters in the facility. LPA toured the facility with HM. There are two staff live-in rooms in the facility for 3 staff. There are 5 single resident rooms in facility. There are 3 restrooms in the facility. LPA toured the Living Room, Family Room, Dinning Room, and Kitchen. Not all the trash cans with covers. HM stated the facility will fix this issue in two weeks. Washing hand posters were observed by the sink. Cloth towel was observed in the kitchen, HM stated facility will remove the cloth towel. Knife closet was observed locked. Medication closet was observed locked. Laundry area was inspected. LPA checked PPE supplies, PPE supplies were observed sufficient. Two day perishable food supplies and seven day non perishable food supplies were observed sufficient. Room temperature was 75 degree F. Hot water temperature was 106 degree F. LPA discussed LIC808 with HM. HM stated all the staff and residents are fully vaccinated, and finished the booster shots. No deficiency or allegation was issued today. Exit interview was conducted with HM. This report was provided to HM for signature. A copy of this report was emailed to Administrator.