Routine inspection·June 22, 2021

Licensing Program Analysts (LPAs) Gary Tan, LaQueena Lacy and Licensing Program Manager (LPM) Naira Margaryan met with Director for Resident Services Adriana Sais and Nurse Liaison Zara Karchatrian for a One (1) Year Required - Infection Control visit for this facility. LPAs explained the reason for the visit. A tour of the physical plant was conducted at 9:32 AM and the following was noted: There is only one entrance being utilized at the facility, the front main entrance door. There are required poster posted at the main door. Screening area is located immediately upon entrance on the receptionist area. All visitors/resident and staff are required to sign in using an automated sign in machine, which automatically record the visit. Hand sanitizer, gloves and masks available upon request to the receptionist. LPAs and LPM was screened upon entry. All staff were observed to be wearing mask upon entrance and during visit. The facility had submitted and approved Mitigation plan. There are hand sanitizing stations all over the facility. There are signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in common bathrooms, elevators and all over the common areas of the facility. The facility have a designated visitors' area in the front entrance yard. The facility has sufficient stock of PPE in the storage room. (continued to LIC 809-C) (continued from LIC 809) Residents' bedrooms on the first, second, third and fourth floors were inspected. Common areas, including the activity rooms, auditorium, center for learning, fitness center, library, dining rooms and reception were observed to be clean and were properly furnished. The kitchen appeared clean and the appliances and fixtures functional. Refrigerated and frozen foods were stored at proper temperatures. There was a sufficient amount of perishable and non-perishable food at the facility and properly stored. Residents do not have access to the kitchen, glass shards however was observed on the floor of the patio area adjacent to the kitchen. There were no pesticides or poisons observed near any food areas. Entry/exits were free of obstruction. The outdoor area was clean and free of hazards. The patios and balconies have proper furnishings. The medications were locked in seven (7) medication carts parked in the first and second floors near the Wellness Room. Random resident rooms were inspected and observed with all the required furnishings and grab bars and nonskid surfaces in the bathrooms, room numbers 101, 123, 222, 420 and 413 grab bars were observed to be loose. Dresser on Room no. 101 was observed to be broken. Hot water temperature in random resident bathrooms were checked. Non-hospice Resident in room no. 338 was observed to have full bed rails and another non-hospice Resident on room no. 225 was also observed to have half bed rails and no written physician's order on file until today. The hot water temperature range from 102.5°F to 126.2°F . Biohazard room located beside the Wellness Room was observed to be unlocked during the visit. LPAs observed fire extinguishers throughout the facility hallways on both floors, all extinguishers were last serviced on 09/21/20. First aid kit was in the medication cart located on the second floor. The facility's smoke alarms are hard wired and the facility is equipped with sprinkler system. Emergency pull cord were tested on random residents' room and observed to be operational. Care staff response however, took approximately twelve (12) minutes to arrive in the room. Citation issued, appeal rights discussed and given. Exit interview conducted. Copy of this report issued.