Routine inspection·December 13, 2022

On 12/13/2022 at approximately 9 AM License Program Analyst (LPA) Hansen arrived unannounced to conduct a Required 1 yr. Infection Control inspection to this facility. LPA was welcomed by Licensee – Cheryl Gambonini. There are 4 residents at facility, currently none on hospice or with dementia. At approximately 9:15 AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been and are in highly visible area. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked closet in the hallway. Water temperature in 2 residents bathrooms measured 111.7 degrees F. & 113.3 degrees F within regulation between 105 degrees F. and 120 degrees F. Fire extinguishers inspected were last charged on 8/17/2021 and has been given a technical assistance for being out of compliance date, although charged (see LIC 9102). Smoke detectors were tested and found to be in working order, but facility did not have carbine monoxide detectors, TA was given to be replaced by end of week (see LIC 9102) Facility has fire sprinklers throughout. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure in locked cart in dining room. Alarms are on all doors leading to outside. Infection Control: Facility has submitted a mitigation program plan and Infection Control Plan. Posters have been placed at facility. Facility has PPE supply stored in locked hallway closet and are placed about the facility for use. Facility has a 30-day supply of medication for residents. Staff had all PPE training required on file. LPA informed Administrator to contact local public health to get staff N95 Fit Tested. Continued on LIC809-C... In addition, facility has a designated area for visitors outside on front porch. Residents also have available telephone calls when contacting with family members and others. LPA reviewed the facility emergency disaster plan with Administrator. Facility has a generator to supply power during an outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternate meeting locations. Facility has supplies enough to operate for more than 48 hours in an emergency. Facility conducts drills twice a year with the last being 8/2022. In addition, facility has a designated area for visitors which are being allowed for visits. Residents also have available Zoom, Facetime, and telephone calls when contacting with family members and others. Staff had all PPE training required on file and have obtained N-95 fit testing. LPA Hansen reviewed Licensing Information System (LIS) with Licensee who stated that is corrected and updated at this time. LPA advised facility to contact Local County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. LPA was presented with proof of current CPR & 1 st Aid certification for staff. Administrator Certificate is for Cheryl Gambonini 6007021740 Exp. 1/08/2023 All staff have received COVID booster vaccinations. Technical Advisories given for Fire Extinguisher to be updated & Carbine Monoxide detector to be replaced There were no deficiencies cited at this time. LPA Hansen is requesting Licensee to update and submit the following documents to CCL by 01/13/2022: LIC 308 Designated LIC 309 Administrative Organization LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurance