Routine inspection·June 7, 2021

On 06072021 at 0943a Licensing Program Analyst (LPA) Troy Agard conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tools. Upon arrival at the facility, LPA Agard conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA verified that the facility has an approved mitigation plan report. The facility is licensed for six (6) non-ambulatory residents and an approved hospice waiver for one (1) resident. Currently, there are two (2) hospice residents present during today’s visit. LPA met with the Caregiver, Rosana Tan and both toured the inside and outside grounds of the facility. LPA was not properly screened for Covid-19 symptoms nor was temperature checked. LPA was properly equipped with Fit tested N-95 and gloves. During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance; visitors log with Covid-19 screening and temperature log. PPE supplies are readily available to staff, and an additional 30-day supply of PPE is stored in a storage room; sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation area is the back patio or front living room. LPA observed staff maintaining 6 feet physical distancing, and each person wears a face covering. LPA observed required postings throughout the facility. LPA was unable to review the facility’s surveillance testing records. According to Administrator, staff are vaccinated and are no longer being covid tested weekly. Staff have not been fit tested for N95. Covid-19 Infection Control and Prevention training records were not available to LPA. In-service training on the approved mitigation plan were not reviewed. LPA did not observe newly admitted residents or newly hired staff. All six residents with memory care needs. All rooms were inspected. Each resident has their own individual room. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. There are no security bars or weapons on the premises. Resident bathrooms were checked, sufficient liquid soap and towels were observed. Toilets and water faucets worked properly, grab bars were secure, the shower was free of mold/mildew. The water temperature measured at 117 F. A comfortable temperature was maintained in the facility. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives were observed unlocked in storage cabinet. Centrally stored medications were observed stored in their originally received containers and kept safe and locked and inaccessible to residents in care. The First Aid kit was available. One fire extinguisher was observed in a box in the corner of kitchen area. Outside grounds were toured, and no bodies of water were observed. Walkways around the home were clear of hazards. Overall facility was a bit cluttered. Doorways were free of obstructions. The following deficiencies were cited: 1) Facility is approved from 1 hospice resident. Facility currently has 2 residents on hospice. 2) Back right stove burner not working. 3) Knives and other sharp items were unlocked The following technical violations were issued: 1) LPA was not screened for covid symptoms upon entry. 2) No N-95 fit testing completed 3) No training for donning and doffing of PPE’s 4) No surveillance testing being conducted. An exit interview was conducted, and a copy of this report was provided to Licensee/Administrator.