Routine inspection·December 27, 2021

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Ed Gadia, co-Administrator. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. LPA conducted a walk-through of the facility with co-administrator and observed COVID-19 precaution postings. A screening station was observed at front entrance of facility which had hand sanitizer, a thermometer, and a sign-in sheet for visitors and staff. LPA was screened for COVID-19 symptoms. Visitors are screened for COVID-19 symptoms (including temperature check) upon arrival to the facility. The facility has designated visitation areas, provides virtual visits and phone calls for family to stay in contact with residents. Staff and resident's temperatures are taken once a day. Staff clean and disinfect the facility throughout the day. LPA observed 4 residents in care. Staff have documented completion on the following training: infection prevention, symptoms, transmission and PPE use. The facility has a supply of PPE including gloves, face shields/goggles, N-95 respirators, surgical masks and disposable gowns. The facility has submitted a COVID-19 Mitigation Plan Report on Epidemic Outbreaks specific to COVID-19 which was reviewed by the California Department of Social Services, Community Care Licensing. LPA discussed Community Care Licensing requirement of verifying COVID-19 vaccination or a negative COVID test within 72 hours for indoor visitation. Co-administrator to obtain documentation for completion of N-95 respirator Fit testing (Cal/OSHA requirement) for staff for CCL verification. Two technical violations were issued today for accessible toxins and lack of non-skid mats/strips in facility bathrooms. The following forms were requested to update the facility administrator (to be submitted to CCL by 01/31/2022): LIC215, LIC500, LIC308, LIC501, copy of Administrator’s certificate Exit interview conducted with co-Administrator, whose signature on this document confirms receipt. No deficiencies cited during this inspection