Routine inspection·October 5, 2021

On 10/05/21 at 12:30PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an infection control annual inspection and explained the purpose of the visit with house manager (HM). LPA spoke to administrator (ADM) on the phone who authorized HM to act on her behalf and sign the reports. LPA observed 2 staff wearing face masks during visit. LPA observed 3 residents relaxing inside their bedrooms. Facility has a mitigation plan in place dated 12/27/20 to mitigate the spread of COVID-19. LPA discussed the completed mitigation plan (LIC 808) with HM 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 with visitor's log, hand sanitizer, face masks and no touch temperature probe. COVID-19 signs were observed posted in the common hallway to promote handwashing, cough/sneeze etiquette and physical distancing. Facility documents daily temperatures and COVID-19 symptom checks for staff and residents. Pathways were observed to be free of obstruction and fire hazards. Continued on next page LIC 809-C A written Emergency/Disaster plan dated 09/12/2019 was posted near a Lan line phone in the kitchen. Centrally stored medications were locked in the kitchen cabinets. Sharp objects were locked underneath the kitchen sink. Toxic chemicals were locked in the laundry room and garage. underneath the kitchen sink.Infection control designated leader is the administrator. All staff and residents have been fully vaccinated since February 2021.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 74 degrees Fahrenheit. Resident's bedrooms and bathrooms have COVID-19 signages. Fire extinguisher was observed fully charged. Smoke and Carbon monoxide detectors were operational. Adequate supplies of PPE were also observed stored in the garage. 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 are to be submitted to CCL on or before 10/06/2021: · 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 HM.