Routine inspection·February 22, 2022

Licensing Program Analyst (LPA) Steve Chang conducted an annual inspection visit, and met with administrator (ADM) Lilian Sacun. Upon arrival, staff Eden Carren (EC) 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 were observed at the main entrance and in facility. 3 staff and 5 residents were observed in facility. LPA toured the facility inside out with EC. LPA inspected living room, kitchen, dinning area, and laundry room. Medication closet, knives closet, and cleaning product closet were observed locked. There are 4 resident single rooms, 1 resident shared room, and one staff live-in room in facility. The beds in shared room were observed 6 foot apart. There are 2 bathrooms are in facility. Some paper towels were observed without holders, Cloth towels were observed in restrooms and kitchen. Some trash cans were observed without covers. EC removed the cloth towel in restroom and kitchen. EC put all paper towel with holders. EC replaced all the trash cans with covers. EC put the washing hands for 20 seconds posters by all the sinks. Room temperature was observed at 71 degree F, and hot water temperature was observed at 108 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. EC tested the smoke and carbon monoxide detectors, and they were working fine. The fire extinguishers were observed on service on 10/06/2021. 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.