Routine inspection·October 25, 2021

At 10:45AM, licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection, and met with administrator (ADM) Bhupinder Kaur. Upon Arrival, facility staff Victor Esteban (VE) took LPA's body temperature, and checked LPA in the visitor log book. LPA observed the COVID posters in the facility. There are one staff live-in room, 3 resident shared rooms, and three restrooms in the facility. LPA observed one empty bedroom and one storage room in the second floor. Not all the trash cans were with covers, ADM stated facility will fix it in two weeks. LPA did not see paper towel in the kitchen, ADM put the paper towel with holder in kitchen immediately. Medication closet was observed locked. Knife closet was observed locked. Cleaning products and detergents were locked in the garage. LPA checked PPE supplies, PPE supplies were observed sufficient. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Beds in the resident shared rooms were observed 6 feet apart. 2 staff and 5 residents were observed in the facility. LPA toured the backyard with ADM. Mattress and some garbage were observed, ADM stated the facility already scheduled 11/02/2021 to remove that. LPA discussed LIC808 with ADM. ADM stated all the staff and residents are fully vaccinated. ADM stated all the residents and staff already finished the booster shots. No deficiency or allegation was issued today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was emailed to ADM.