Routine inspection·February 28, 2023

Licensing Program Analyst (LPA) Delmundo conducted an unannounced annual/infection control inspection. LPA met with met with staff, Infection Preventionist LVN Cynthia Angeles and AL Supervisor Rosario "Charo" Quispe Figueroa, and informed the purpose of visit. Facility has an approved LIC808 Mitigation Plan. Facility has not submitted the LIC9282 Infection Control Plan. LPA toured the facility inside out with Cynthia Angeles and Rosario Figueroa. LPA inspected the living room, dining area, kitchen, hallways, 3 common bathrooms. LPA randomly selected 6 residents' rooms for inspection. There's adequate food supplies of perishables good for 2 days and non-perishables good for 7 days. Central storage for medication and salon/staff lounge room were observed locked. Facility has screening station with hand sanitizer, no touch temperature probe.. Facility has Visitor's log. Temperature and symptom checks are done at the entrance. Facility keeps record of proof of vaccination of residents and staff. Supplies of PPEs were sufficient.. Facility has antigen test kits readily available. COVID-19 signages were observed all throughout the facility. Bathroom lavatories were observed with liquid soap and paper towels in dispensers for hand drying. Trash cans were observed with no touch lids. Fire extinguishers checked, observed fully charge with tags showed serviced February 17, 2023. Hot water temperature in one of the common bathrooms was tested and measured at 119 degrees Fahrenheit. .......continued on 809C Adminstrator to submit the following by March 14, 2023: 1. LIC308 Designation of Facility Responsibility 2, LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. Proof of $3M liability insurance. 5. Staff's current N95 fit testing records/certificates 6. LC9282 Infection Control Plan No deficiency observed during today's visit. Exit interview conducted and and copy of this report provided.