Routine inspection·February 9, 2022

On 2/9/2022 at 11 AM Licensing Program Analyst (LPA) Jaclyn Avila arrived at the facility unannounced to conduct a Required - 1 Year Inspection utilizing the infection control domain, LPA met with licensee/administrator Marites Menros and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask. LPA Avila and Marites toured the facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Avila and the licensee completed the infection control domain and facility was found to be in need of technical assistance. LPA requested the following documents due by 2/11/2022 Register of Residents Number of non-ambulatory/bedridden person in care Personnel Report LIC 500 Emergency and Disaster Plan for RCFE (LIC 610E) LIC 808 Copy of Administrator Certificate LIC 9242 No deficiencies are being cited as a result of todays inspection. Technical assistance was provided. Exit inter view conducted and copy of report was provided.