Routine inspection·April 21, 2022

On 04/21/2022 at 9:00 AM, Licensing Program Analyst (LPA) J. Sampair conducted an unannounced infection control and annual inspection. LPA explained the purpose of the visit and toured the facility with Rosa Quiambao. The LPA observed staff wearing masks as well as a complaint poster, personal rights, Ombudsman and rights to council posters were displayed. LPA observed the 3 residents resting in their bedrooms and watching television during the visit. All staff and all clients are fully vaccinated, including all of the appropriate boosters. LPA toured the facility inside and outside including but not limited to resident's bedrooms, bathrooms, dining room, common living areas, kitchen, and outside patios. There is sufficient lighting around the facility. Resident's rooms were equipped with the proper furniture and lighting. Resident's rooms had proper bedding and linens. Bathrooms were equipped with grab bars, nonskid mats, and hygiene items. Living room is equipped with the proper furniture for the residents. Hot water temperature was measured at 110 degrees and room temperature at a comfortable 68.7. Sufficient 2 day perishable and 1 week non-perishable food supplies were observed in the refrigerator, freezer, and kitchen cabinets. Passageways and hallways were free of obstruction. Fire extinguisher is fully charged. Smoke and Carbon Monoxide detectors were operational. Medication cabinet was locked and first aid kit was complete. However, the LPA issued 8 different Type B citations that include: lax Infection Control Practices, Physical Plant and Environmental Safety issues, missing Incidental Medical and Dental documentation, and lacking Disaster Preparedness. Continued on next page LIC 809-C Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 05/05/2022: • LIC500 - Personnel Report • LIC308 - Designation of Facility Responsibility • LIC610D - Emergency/Disaster Plan • Evidence of Liability Insurance & Surety Bond Exit interview conducted and a copy of this report provided via email.