Routine inspection·November 11, 2022

Licensing Program Analyst (LPA) Delmundo conducted an unannounced infection control annual inspection. LPA met with Fekerte Hyesus, administrator, and informed the purpose of visit. Facility has LIC808 Mitigation Plan on file. LPA toured the facility inside out with the administrator. LPA inspected the living room, dining area, kitchen, bedrooms, bathrooms, side and backyard. There's adequate food supplies of perishables good for 2 days and non-perishables good for 7 days. LPA observed screening station located near the entrance with visitor's log, hand sanitizer and thermometer. Surgical masks and disposable gloves are readily available at the screening station. Temperature and symptoms check are done at entry for visitors. Antigen test kits are readily available. Residents and staff are screened for COVID-19 symptoms and temperature is checked and recorded. COVID-19 signages were observed posted all throughout the facility. Supplies of PPEs inspected. Staff were fit tested for N95 respirators. Hot water temperature in the common bathroom was tested and measured at 105.2 degrees Fahrenheit. Fire extinguishers checked, observed fully charge with tags showed serviced November 8, 2021. Administrator provided to LPA on this day copies of the following: 1. New Infection Control Plan 2. $3M liability insurance certificate ......continued on 809C Administrator to submit the following by November 25. 2022: 1. Monkeypox Infection Control Plan 2. LIC308 Designation of Facility Responsibility 3. LIC500 Personnel Report 4. LIC610E Emergency Disaster Plan (9 pages) No deficiency observed. Exit interview conducted and copy of this report provided.