Routine inspection·February 24, 2023

Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 02/24/2023 to conduct a required - 1 year inspection. LPA was greeted and screened by staff. LPA met with staff, Edward Alicdan. This inspection is focused on the infection control practices and procedures of this facility. LPA toured building and grounds which were found to be clean and in good repair. Facility currently has six residents. Facility had sufficient perishable and non-perishable food. Fire extinguishers inspected were charged and current. Toxins were locked and secured. Medications were centrally stored and locked. Carbon monoxide and smoke detectors were present and operational. Walkways were cleared and unobstructed. High touch surface areas are disinfected daily. LPA observed COVID postings at the front entrance. Staff and residents are all fully vaccinated. Facility has necessary Personal Protective Equipment to support a resident in isolation. LPA and administrator discussed resident/staff record keeping. Staff and visitors were observed wearing masks. LPA requested the following documents be submitted to Community Care Licensing within 30 days of today's inspection: LIC 308 Designation of Facility Responsibility Liability Insurance LIC 610 Emergency Disaster Plan LIC 9020 Resident Roster LIC 500 Personnel Report No deficiencies observed during today's inspection. Exit interview conducted with Edward Alicdan and a copy of the report emailed to facility.