Routine inspection·November 16, 2021

On 11/16/21 at 10:00AM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an infection control annual inspection and met with administrator (ADM). LPA explained the purpose of the visit with ADM. During visit, LPA observed 5 residents at the facility, 3 watching TV and 2 resting inside their bedrooms with one staff wearing a face mask. Facility has a mitigation plan in place dated 01/23/21 to mitigate the spread of COVID-19. LPA discussed the completed mitigation plan (LIC 808) with ADM as well as COVID-19 infection control practices. LPA inspected the facility inside and outside. Facility room temperature was maintained at 73 degrees Fahrenheit. Resident's bedrooms and bathrooms have COVID-19 signages. Fire extinguisher was observed fully charged. Smoke and Carbon monoxide detectors were operational. 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. Continued on next page LIC 809-C Facility documents daily temperatures and COVID-19 symptom checks for staff and residents. Pathways were observed to be free of obstruction and fire hazards. A written Emergency/Disaster plan dated 01/20/21 was posted near a Lan line phone in the kitchen. Centrally stored medications were locked in the kitchen cabinets. Sharp objects were locked inside the kitchen drawer. Toxic chemicals were locked in the garage. Infection control designated leader is the ADM. All staff and residents have been fully vaccinated with booster shots since 11/10/21.There was at least 7 days of nonperishable and 2 days of perishable foods. Emergency food supplies were observed stored in the garage. 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 11/14/2021: · 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 ADM.