Routine inspection·July 8, 2021

On 07/08/21 at 3:30PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an infection control annual inspection and explained the purpose of the visit with administrator. LPA observed 7 staff wearing face masks during visit. LPA observed 10 residents playing bingo in the main visitation room with two staff wearing face masks. LPA observed screening station located at the front desk with staff entering information on the visitor's log and using the no touch temperature probe for daily symptom screening (+/-) temperature & symptom check. Routine symptom screening (+/-) temperature and symptom check) is done at entry for all staff, residents and visitors. Facility has a completed mitigation plan in place dated 06/01/2021 to mitigate the spread of COVID-19. LPA discussed the completed mitigation plan (LIC 808) with administrator as well as COVID-19 infection control practices. LPA inspected the facility inside and outside. LPA observed facility walls, bedrooms, bathrooms and common areas were freshly painted. Administrator stated COVID-19 signages will be posted again in common areas to promote hand washing, cough/sneeze etiquette and physical distancing. Continued on next page LIC 809-C Facility documents daily temperatures and COVID-19 symptom checks for staff and residents. Pathways were observed to be free of obstruction and fire hazards. Facility has living areas with furniture spaced six feet apart for social distancing among residents. All staff and residents have been fully vaccinated since May 2021. There was at least 7 days of nonperishable and 2 days of perishable foods. Infection control designated leader is the administrator. Emergency food supplies were observed stored in locked storage room. Medications were observed locked in medication carts outside the medication room. Infection control leader is the administrator. Facility room temperature was observed at 70 degrees F per thermostat reading. A certified administrator is on site a minimum of 20 hours a week to oversee proper business operation and compliance with COVID-19 infection control practices. Fire extinguishers were observed fully charged. Smoke and Carbon monoxide detectors were operational. LPA observed communal dining area with tables six feet apart. Updated copies of the following documents will be emailed to LPA by administrator on 07/12/21: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610E- Emergency/Disaster Plan · Evidence of Liability Insurance No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided to administrator.