Routine inspection·June 29, 2021

On 06/29/21 at 12PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an infection control annual inspection and explained the purpose of the visit with administrator. LPA observed 3 staff wearing face masks during visit. LPA observed 2 residents not wearing face masks in the living room watching TV. The other 2 residents were observed resting in their bedrooms. Facility has a mitigation plan in place dated 04/22/21 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. One central entry point has been designated for universal entry screening with the station located near the front entrance. LPA observed staff check LPA temperature by using the no touch temperature probe and logging the information on the visitor's log. Facility documents daily temperatures and COVID-19 symptom checks for staff, residents and visitors. COVID-19 signs are posted throughout the facility to promote handwashing, cough/sneeze etiquette and physical distancing. Pathways were observed to be free of obstruction and fire hazards. A written Emergency/Disaster plan dated 04/04/21 was observed posted on the bulletin board near the dining area. Centrally stored medications were locked in the kitchen cabinet island. Sharp objects were locked underneath the kitchen sink. Toxic chemicals were locked in the laundry room. Continued on next page LIC 809-C Infection control designated leader is the administrator. All staff and residents have been fully vaccinated since February 12, 2021. There was at least 7 days of nonperishable and 2 days of perishable foods. Emergency food supplies were observed stored in the kitchen cabinets and in the garage. Facility room temperature was maintained at 74 degrees Fahrenheit. Resident's bedrooms and bathrooms have COVID-19 signages. 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 extinguisher located in the dining area was observed fully charged and last inspected on 11/19/2020. Smoke and Carbon monoxide detectors were operational. Adequate supplies of PPE were also observed stored in the laundry room. Facility follows daily cleaning, sanitation of frequently touched common surfaces using Clorox and Lysol disinfectants. The facility has auditory signals on each exit door. Updated copies of the following documents were requested for facility file and to be submitted to CCLD on or before 07/07/21: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610D- 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.