Routine inspection·February 28, 2022

Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced Required One (1) year Infection Control inspection to the facility. LPA met with Administrator Mark Yule and explained the reason for the visit. A tour of the physical plant was conducted at 10:03am and the following was noted: There is only one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, and masks are available. LPA was screened upon entry. The facility had submitted and approved Mitigation Plan. Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the door. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. The facility has five (05) bedrooms and three (03) bathrooms currently occupying five (5) residents. One (01) room is a shared room and four (04) rooms are private rooms. (continued on LIC 809-C Living and dining room furniture were also checked. The living room is neat and clean. The facility maintains a comfortable temperature at 71 degrees. The smoke detectors are hardwired and interconnected and observed to be operational. There is a carbon monoxide detector in the facility. Fire extinguishers are located in the kitchen, The backyard of the facility has outdoor furniture with a covered shaded area for residents. There is no body of water at the facility. There is also a shed at the backyard being used as equipment storage. Laundry area is located in the back of the facility, laundry detergents, cleaning agents and other toxins were observed to be locked. Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents. The residents rooms are adequately furnished with appropriate furniture and lighting system. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the shower and toilet. The hot water temperature was measured at 105 degrees. There was enough clean linen available in stock at the cabinet. Medications-LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. There is one (01) complete first aid kit. Exit interview conducted. A copy of this report was issued and signature obtained.