Routine inspection·March 8, 2022

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection with the focus of the Infection Control domain. LPA arrived unannounced and met with the Administrator, Gregory Restum. The purpose of the visit was explained. The facility is licensed for a capacity of 22 individuals, of which 12 may be non-ambulatory or 12 bedridden (1st floor only). The hospice waiver is approved for 12 residents. LPA toured the 2-story facility with the house supervisor. The following was observed: * The first floor consists of 10 bedrooms, 3 bathrooms, 2 closets, office space, and the kitchen. The second floor consists of 8 bedrooms and 2 bathrooms. The backyard consists of tables and chairs with shades. There are no items obstructing the passageways. The residents' rooms have the required furniture. LPA observed signage posted at the front entrance and around the facility and bathrooms. LPA recommended to add additional signage such as sneeze/cough etiquette in the dining room. Temperature is taken for visitors upon entering and logged. LPA recommended to continue the covid-19 screening questionnaire while taking their temperature. Per Staff, they are checking residents' temperature every shift. They are also cleaning and disinfecting highly touched surfaces on every shift. Food supplies for 2 day perishable and a week of non-perishable are also observed. Knives, cleaning solutions, and disinfectants are stored and locked making them inaccessible to clients. LPA tested the hot water temperature in all the communal use bathrooms and the bathroom between room #18 and #19 measured at 143 degree Fahrenheit, which is over the required range of 105 - 120 degrees F. Smoke detectors are hard wired and located in each room and a carbon monoxide detector is located on each floor. 3 Staff files reviewed have the health screening form and TB test results. The medications are centrally stored and locked. LPA reviewed medications for 5 residents and found discrepancies in 4 out of the 5 medications. LPA provided a technical advisory for the N95 Fit Testing. Deficiencies were documented on the LIC809D. An exit interview was conducted and a copy of this report along with appeal rights were provided.