Routine inspection·March 24, 2022

Licensing Program Analyst (LPA) Martessa Brown conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA was met by Susan Park, Administrator and the purpose of today’s visit was explained. The facility is licensed to serve 120 non-ambulatory residents of which 35 may be bedridden (room 100-116,228, 302-329). Hospice waiver for a total of 10 and approved for delayedegress. There are currently 69 residents and which 4 are on hospices . LPA and staff toured the physical plant along with the administrator. The tour consisted of the following: First Floor: Common/Reception area, TV/Entertainment Room, court yard, dining room and kitchen, administrative office, lobby, kitchen, business office, storage room, resident bedrooms, elevator, storage area and bathrooms. Second Floor: activity room, storage rooms, resident bedrooms. Third Floor: dining room, staff lounge, storage rooms, resident bedrooms. There is also an underground parking structure and courtyards and storage area. LPA observed the residents and they appeared to be fine. There are no bodies of water or firearm/ammunition on the premises. Residents rooms were checked. Beds and bedding were in good condition, adequate lighting provided, bathrooms and closets were inspected. LPA observedWalls and floors were in good repair. Medicine room is located on the 1 st fl, LPA observed medicines were stored and locked and observe residents medicine files. Bathrooms were found to be within Title 22 regulations and were clean and operational along with hand soaps, papertowel dispenser and hand sanitizers. The water temperatures measured at between 108 and120 F. A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is an enough perishable and non-perishable food available which is stored properly. Fire extinguisher was charged, smoke detectors and Carbon Monoxide were operable. LIC 809-C is on the next page. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations ( Located in common areas and restrooms). LPA observed staff and residents were wearing face coverings, an isolation room and required postings throughout the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. During today’s visit there were no deficiencies observed. Exit interview held. A copy of the report was provided to Taehee Lee..