Routine inspection·September 16, 2021

Licensing Program Analyst (LPA’s) Martessa Brown and Licensing Program Manager (LPM) Janae Hammond conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA was met by Garrix Manuel, Caregiver and the purpose of today’s visit was explained. The facility is licensed to serve 6 Residential Care Elderly. There are currently (6) residents at the facility, 6 Non-Ambulatory of which 1 may be bedridden. LPA and LPM observed all 6 residents were fine. The facility is a single story structure located in a residential neighborhood. Home consists of the following: 5 bedrooms, 2 bathrooms, family room/dining room, kitchen, living room, outdoor shaded area. LPA and staff toured the physical plant with the Caregiver. There are no bodies of water or firearm/ammunition on the premises. All residents bedrooms were checked. Beds and bedding were in good condition, adequate lighting provided. Walls and floors were in good repair. 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 102 F. A comfortable temperature is maintained in the facility. 2 nd bathroom was designated for staff only. 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 enough perishable and non-perishable food available which is stored properly. Fire extinguisher was in the medicine cabinet and not mounted on the wall, smoke detectors were operable but there was no Carbon Monoxide at the facility. LIC 809-C is on the next page During the visit, LPA observed did not observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA observed staff were wearing face coverings. LPA did not observe an isolation room with the required postings throughout the facility. LPA did observe the facility During the visit, LPA observed did not observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA observed staff were wearing face coverings. LPA did not observe an isolation room with the required postings throughout the facility. LPA did observe the facility as a 30-day supply of Personal Protective Equipment (PPE). LPA observe a couple of “No Visitors signs” that should be removed. Administrator should 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. Deficiencies may be issued at a later date. Exit interview held. A copy of the report was provided to Caregiver.