Routine inspection·October 22, 2021

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on the infection control domain, review of medication and food. LPA met with Paula Digerness administrator and explained the reason for the visit. Facility is licensed to serve as a Continuing Care Residential Community (RCFE-CCRC) for 340 non ambulatory adults 65 and over, of which 5 may be bedridden in rooms 150-169. Delay Egress is approved in1st and 2nd floor and a secured perimeter is approved in the 1st floor . Facility has an approved hospice waiver for 20 residents. Facility has a commercial kitchen, a swimming pool with a 5ft fence surrounding accessible with a key card pad, a gym, a dining room, library, different common areas in the 1st, 3rd, and 5th floor, and a dementia unit with delay egress system. Facility is currently serving 18 hospice residents. LPA conducted a tour of the facility with administrator Paula Digerness which consisted of the following: Kitchen - staff #1 observed wearing face mask under the nose. Refrigerators, freezer, and pantry were observed with sufficient food supplies LPA observed at least 2 days of perishables and 7 days of non-perishables, and temperature was observed at 40 degrees for refrigerators and 0 degrees for freezer. The following resident rooms were observed with all furniture, bedding, and light fixture as follow: Independent Living Room #444,519,437,302,542,205,314. Assisted living services rooms #252 - half bed rails observed, #215 - windex bottle cleaner observed on top of bathroom ,#405 ,#312 half bed rails observed,#524 knife and medication observed in kitchen area,#268, #529 knife in kitchen and PRN medication/cleaning supplies in unlock closet in hallway, #352 half bed rails and PRN medication observed in bathroom, #454 knife set in kitchen and half bed rails observed. Dementia unit rooms #159 half bed rails observed, #161 half bed rails observed, #168, #169 half bed rails observed. Each resident with half bed rails has a physician's request on file. Water temperature was tested in each room between 108.9 - 119.8 degrees F which is within the required water temperature of 105 - 120 degrees F. (CONTINUED LIC 809C) Facility is following COVID 19 recommendations regarding: screening conducted for staff/residents/visitors, signs are posted throughout, cleaning and disinfecting done at least each shift in high touch areas, care staff has been Fit test for N95s, staff #1 was observed wearing mask under nose in the kitchen area, #2 observed not wearing a face mask while cleaning a resident's room, staff #3 was observed not wearing a face mask while providing care for a resident in room #312, and an out source contractor providing activities in the dementia unit was observed wearing a face mask under the nose. Technical Advisories were provided for infection control deficiencies. Administrator Certificate #6027186740 expiration date 6/17/21 was observed along with forms submitted to the department for renewal of certificate. LPA was unable to review medication during this visit due to time restrains and will return at a different time to finish annual review. Deficiencies were given during this visit under Title 22 Division 6 Chapter 8 and noted on LIC 809D. Exit interview conducted with administrator Paula Digerness and a copy of this report LIC 809D, and appeal rights were provided.