Routine inspection·October 24, 2022

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Elsa Magaoay, Caregiver. 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. Facility has a COVID-19 screening station (visitor sign-in sheet, COVID questionnaire, thermometer, hand sanitizer). Fire extinguisher was charged and serviced 11/17/2021. The facility has an supply of PPE including gloves, hand sanitizer, N-95 respirators, gowns, face shields, and surgical masks. The facility has submitted their Infection Control Plan to the California Department of Social Services, Community Care Licensing. All staff wore face masks during this visit. LPA will return at a later date to verify staff vaccination records, N-95 Fit Testing requirements, and staff training. LPA requested the following updated forms to be submitted to Community Care Licensing by 11/21/2022: · LIC 308 Designation of Facility Responsibility (1 person per form) · LIC 500 Personnel Report · LIC 400 Affidavit Regarding Resident Cash Resources (indicate if not handling cash for residents) · Liability Insurance · LIC 610E Emergency Disaster Plan · LIC 9020 Register of Facility Residents/clients · Copy of current Administrator's Certificate · Copy of current Lease/Rental Agreement or Property Tax document showing control of property. Exit interview conducted with caregiver, whose signature on this document confirms receipt. **No deficiencies cited during this inspection