Routine inspection·October 28, 2021

Licensing Program Analyst (LPA) James Sampair conducted an infection control annual inspection of the facility inside and outside. Upon entry into the facility, LPA observed that 0 of 2 staff members were wearing any facial covering, nor did they ask him to verify his vaccination status. There was a screening station located near the front entrance. COVID-19 signs were posted in common areas to promote hand washing and physical distancing. Staff document temperature and health status for staff and residents on a daily basis. Within 30 minutes, the Administrator (ADM) and designated Infection control leader Anna Manglicmot arrived. The LPA explained the purpose of the visit and the ADM accompanied him during the tour of the facility. The ADM reported that all staff and residents were fully vaccinated. The LPA observed that the temperature within the facility was maintained at a comfortable temperature, but the hot water was over the maximum of 120 degrees Fahrenheit. There were sufficient food and water supplies. The Smoke and Carbon monoxide detectors were fully operational. and the fire extinguishers were fully charged and last inspected in August 2021. Though staff had been trained in the past on infection prevention, symptoms, transmission, and proper donning and doffing of PPE, no copy of the COVID-19 mitigation plan was at the facility, so the LPA reviewed several infection control topics with the ADM, including: verifying vaccination status for visitors, FIT testing, and the proper amount of PPE necessary during an outbreak. In addition to the deficiencies noted above, a total of 4 Type A and 3 Type B, and 2 Technical Assistances, the details of which are in the LIC809-D citations: -------------Continued on LIC809-C--------------- Infection Control Practices - Technical Assistance: 2 staff not wearing face covering upon LPA entry Infection Control Practices - Technical Assistance: not a 30 day supply of PPE Physical Plant/Environmental Safety - Type B: 87303(a) - gate giving access to unlocked storage shed could not close Physical Plant/Environmental Safety - Type A: 87303(e)(2) - hot water temperature 122 degrees F Physical Plant/Environmental Safety - Type A: 87309(a) - knives were stored in unlocked drawer in kitchen and cleaners in unlocked cabinets in laundry room Incidental Medical and Dental - Type A: 87465(h)(2) - medication cabinet unlocked Disaster Preparedness - Type B: 1569.695(a)(2) - no emergency food and water nor a fully developed plan Disaster Preparedness - Type B: 1569.695(a)(7)(A) - no emergency generator Residents with Special Health Needs - Type A: 87606(c) - 1 bedridden resident retained without license to do so Exit interview was conducted and a copy of this report and copies of the Appeal Rights were provided.