Routine inspection·June 17, 2021

On 06/17/21 at 2PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an infection control annual inspection and explained the purpose of the visit with S1 and S2. LPA spoke with administrator who was not available during visit. Administrator gave authorization for S2 to sign the annual inspection reports. LPA observed 2 staff wearing face masks during visit. LPA observed 2 residents relaxing in the living room while the other 4 residents were resting in their bedrooms. Facility has a completed mitigation plan in place dated 03/12/21 to mitigate the spread of COVID-19. LPA discussed the completed mitigation plan (LIC 808) with staff as well as COVID-19 infection control practices. LPA inspected the facility inside and outside. LPA observed a screening station located near the front entrance with visitor's log, hand sanitizer, gloves, face masks, 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. Facility documents daily temperatures and COVID-19 symptom checks for staff and residents. Pathways were observed to be free of obstruction and fire hazards. LPA observed furniture spaced six feet apart for social distancing among residents in the living room. Continued on next page LIC 809-C Infection control designated leader is the administrator. All staff and 5 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 72 degrees Fahrenheit. 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 was observed fully charged and last inspected on 05/12/21. Smoke and Carbon monoxide detectors were operational. LPA observed a written Emergency Disaster Plan dated 5/12/21 posted in the bulletin board next to the kitchen area. LPA also observed PIN 20-38-ASC posted and emergency contact information. Updated copies of the following documents were obtained during visit: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610E- Emergency/Disaster Plan · Evidence of Liability Insurance No deficiencies were observed during the infection control annual inspection. Exit interview conducted and a copy of this report provided.