Routine inspection·November 29, 2022

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Anny Camerino Administrator & Licensee. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. LPA toured the facility, all exits were unobstructed, and observed the facility to be clean and at a comfortable temperature. Facility has a COVID-19 screening station (visitor sign-in sheet, COVID questionnaire, thermometer, hand sanitizer). Combination smoke detector and carbon monoxide detectors were tested and observed operational. Fire extinguisher was charged and serviced 07/25/2022. Staff clean and disinfect the facility throughout the day. LPA observed COVID-19 precaution postings, liquid hand soap and paper towels available in bathrooms. LPA verified N-95 Respirator FIT testing for staff (Cal/OSHA requirement) was completed. The facility has a supply of PPE including gloves, hand sanitizer, N-95 respirators, gowns, face shields, and surgical masks. LPA verified staff have current CPR/First Aid certifications. LPA requested the following updated forms to be submitted to Community Care Licensing by 12/28/2022: · LIC 308 Designation of Facility Responsibility (1 person per form) · LIC 500 Personnel Report · LIC 400 Affidavit Regarding Client/Resident Cash Resources (indicate if not handling cash for residents) · Copy of liability insurance · LIC 610E Emergency Disaster Plan · Copy of current Administrator's Certificate · Copy of current Lease/Rental Agreement or Property Tax document showing control of property. Exit interview conducted with Administrator whose signature on this document confirms receipt. **No deficiencies cited during this inspection