Routine inspection·May 10, 2022

Licensing Program Analyst (LPA) Cynthia Chan conducted an unannounced site visit for the required annual inspection. Upon arrival at the facility, LPA met with Staff, Linda King, who assisted with the visit. Administrator, Pearl He, arrived shortly thereafter to join the inspection. The facility is licensed to serve a total of 6 residents, one may be bedridden and 5 non-ambulatory ages 60 and above. The hospice waiver is approved for 1 resident. LPA utilized the infection control domain for the inspection and also reviewed medications and food supplies. The facility consists of 3 separate units on the same lot. Each unit consists of 2 resident bedrooms, one bathroom, living room, dining room, and kitchen. There are 2 separate garages located in the back. There are no pools or bodies of water at the location. During today's visit, LPA observed one bedridden resident in the front unit (940), no residents residing in the middle unit (942), and 2 residents in the back unit (944). The facility has a sign in station with masks and hand sanitizers available at each of the unit. Covid-19 signage are posted at each of the units. LPA requested for the Administrator to include the hand washing signage in the bathrooms and kitchen. There were at least 30 days of PPE supplies in storage. Disinfectants and cleaning solution are properly stored making them inaccessible to residents. Staff were observed wearing face masks. LPA reviewed the medications for all 3 residents. LPA issued citations for the following items: * A week of non-perishable items were not observed at the facility. * 2 of the medications for Resident #3 had not obtained the refills, therefore, LPA observed the bottles empty. Per the administrator, the family obtains the refill but has not brought them over. The deficiencies are cited on the LIC809D. A copy of this report and appeal rights were provided.