Facility Evaluation Report

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting an Annual Inspection. LPA met with Staff #1 (S1) Nenita Mandapat and discussed the purpose of the inspection. Administrator (AD) Cora Kon appeared via telephone. During the inspection, LPA and S1 conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following:

During the inspection, LPA observed there were 3 staff present, wearing PPE. LPA observed 2 residents were present. LPA confirmed all residents were doing well and observed no health and safety issues. LPA inspected common areas, resident rooms, kitchen, and garage and observed they were clean and organized, and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA observed hallways and walkways were free of obstruction. LPA reviewed and confirmed facility policies and practices regarding resident screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, staffing, infection control/lead/training, PPE, staffing and staffing shortages, and communication and emergency plan. LPA requested and reviewed the COVID-19 Mitigation Plan, Emergency Disaster Plan, and resident files. LPA advised AD to ensure that an up to date Resident Roster and a Staff Roster are available at the facility. LPA provided technical assistance regarding N95 Fit Testing and Emergency Disaster Plan. LPA advised AD to review Provider Information Notice (PIN) 22-18-ASC, as well as related PINs, and submit the Infection Control Plan immediately if AD has not already done so.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.