Routine inspection·June 1, 2021

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Wellness Director Mele Liu and explained the purpose of the visit. The facility does not have a Dementia waiver. A hospice waiver for 6 residents is in place. Facility is a 3-story building consisting of 72 resident rooms, 2 common areas, 1 living room/activity room, dining room, kitchen, laundry room, and a courtyard patio area. The facility's last fire inspection was conducted on 3/2/2021. NOTE: New Administrator Rosie Julinek was not present during today's visit. The following was inspected and observed during the inspection: The facility main entrance does not have required COVID-19 signs posted at the entrance. Visitors are screened in the main entrance and a log is kept. Signs are not posted throughout the facility in common areas, hallways, and public restrooms to promote handwashing, cough/sneeze etiquette, and physical distancing. Facility has single-person isolation rooms. Twelve (12) resident rooms were inspected. None of the rooms. 11 resident rooms did not have alcohol based hand sanitizer. Rooms 236 and 305 did not have soap for handwashing. Six (6) centrally stored resident medication records were reviewed. Two (2) residents [R1 & R2] MAR records were not accurate. Medications were listed on Medication Administration Record (MAR), but staff stated the medications have not been re-ordered because medications should be discharged. Physician discharge orders were not observed. One (1) housekeeping staff was observed not wearing mask. The majority residents walking or lounging in common areas were observed not wearing masks. Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed. Lunch dining service was observed. All residents were socially distanced according to local public health guidelines. Due to technical issues 1 deficiency page did not print. The complete report will be emailed tomorrow. Deficiencies were cited. See LIC809D. Exit interview was conducted with Mele Liu. A copy of the report and appeal rights were issued.