Routine inspection·June 18, 2021

On 06/18/21, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with administrator Justin Vicerra and explained the purpose of today’s visit. The facility is licensed to operate for six (6) residents of which all six (6) can be bedridden elderly residents ages 60 and above. The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) resident's rooms, one (1) staff room, three (3) bathrooms, living area, dining area, kitchen, and outside covered patio area. LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 110.8 F to 113.4 F in the bathrooms and kitchen. A comfortable temperature of 74 degrees was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Two (2) fire extinguishers were charged, smoke detectors and carbon monoxide were operable. A review of Medication Administration Records (MAR) was maintained in order and accurate. Evaluation Report Continues on LIC 809-C During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff and residents were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. Advisory Notes - Technical Assistance was issued, please see LIC9102-AN. There was one deficiency cited during this inspection visit, please see LIC 809D page. An exit interview was conducted and a copy of this report was provided to Justin Vicerra.