Routine inspection·June 11, 2021

Licensing Program Analyst (LPA) M. Medina conducted an Annual Inspection on this date. LPA was met by Licensee, Fe Domingo and stated the purpose of the visit. A tour of the facility was conducted. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms toured, resident bedrooms have a minimum of 6 feet between beds. Fire extinguisher present and has a service date of 11/12/2020. Carbon monoxide detector present and observed to be operational during today's inspection. Hot water measured at 112 degrees F. LPA checked residents’ medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. Resident’s files have updated emergency contact information. Mitigation plan received and approved by Department on 3/26/2021. Fe Domingo also serves as facility Administrator certification #6015208740, expires 7/15/2022. First/CPR expires 5/28/2022. No deficiencies were observed. Exit interview was conducted. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed.