Routine inspection·February 11, 2022

On 02/11/22 at 1:45PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an infection control annual inspection and explained the purpose of the visit with administrator. LPA observed 2 staff wearing face masks during visit with 5 residents watching TV while the other resident was resting inside her bedroom. Facility has a completed mitigation plan in place dated 02/12/2021 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 screening station located near the front entrance with visitor's log, hand sanitizer, gloves, face masks and no touch temperature probe. Routine symptom screening (+/-) temperature and symptom check) is done at entry for all staff, residents and visitors. LPA observed COVID-19 signages posted in common areas to promote hand washing, cough/sneeze etiquette and physical distancing. Pathways were observed to be free of obstruction and fire hazards. Facility has a visitation area with furnitures spaced six feet apart for social distancing among residents. A written Emergency/Disaster plan dated 01/08/22 was posted near the sliding back door. Centrally stored medications were locked in cabinets. Sharp objects were locked in the kitchen drawers. Continued on next page, LIC 809-C Toxic chemicals were locked in the laundry room and garage. Administrator stated a portable PPE cart is available for use outside of the isolation room. Facility has conducted staff training on infection prevention, symptoms, transmission and proper donning & doffing of PPE. LPA advised administrator to replace all open trash bins with lid operated with foot pedal for the kitchen, bathrooms and bedrooms. Infection control designated leader is the administrator. All 3 staff and 6 residents have been fully vaccinated, 1st dose 2/02/21, 2nd dose 2/23/21 Pfizer).There was at least 7 days of nonperishable and 2 days of perishable foods. Emergency food supplies were observed stored in the garage. Facility room temperature was maintained at 72 degrees Fahrenheit. 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 was observed fully charged. Smoke and Carbon monoxide detectors were operational. No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided via email to administrator.