Routine inspection·August 23, 2021

Licensing Program Analyst Steve Chang conducted an unannounced Annual Inspection today, and met with administrator (ADM) Eugene Castillejo. Upon arrival at the facility, staff Adelina Hufana(S1) took LPA body temperature, and asked if LPA had the symptoms of COVID, then checked in LPA in the visitor log book. The rosters of residents and staff were obtained. LPA toured the facility with S1 inside out. There are 3 shared resident bedrooms, and one staff live-in bedroom in facility. There are 2 bathrooms in facility. LPA observed the COVID-19 posters in the facility. LPA observed all the trash cans were with covers. LPA observed the beds in the resident rooms were 6 feet apart. LPA observed the medication cabinet was locked. LPA inspected the food supplies. The 2 day perishable food and 7 day nonperishable food were sufficient. LPA observed another staff Evelyn Pelobello (S2) in the facility. LPA observed 3 residents (R1- R3) in the facility. S1 stated the resident Julia Droze (R4) was in hospital. LPA discussed and reviewed LIC808 with ADM. ADM stated all the staff and residents are fully vaccinated. No citation were issued during today's inspection. Exit interview conducted with ADM. This report was provided to ADM to review and to sign. A copy of this report was emailed to ADM.