Routine inspection·January 4, 2022

Licensing Program Analyst (LPA) Abeye Duguma met with the Executive Director, Irma Ateaga, for a One (1) Year Required - Infection Control visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 3:00pm and the following was noted: There is one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, infrared thermometer, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing masks upon entrance and during the visit. Signs to wear masks 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 the bathroom and all over the facility. The facility has a designated outdoor visitors' area located on the second floor of the building. The facility has sufficient stock of PPE in a storage cabinet located in the maintenance office. The facility has a total of seventy-three (73) bedrooms each with its own bathroom and four (04) public restrooms for both residents and staff. The facility is fire cleared for eighty-five (85) non-ambulatory and a hospice waiver for eight (08). The facility is currently occupying forty-one (41) non-ambulatory and four (04) ambulatory residents. The facility has outdoor furniture, with a covered shaded area for residents. The facility does not have a swimming pool/body of water. The garage is being used for parking. Laundry detergents, cleaning agents and other toxins are stored in a in the laundry room. Kitchen was sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. (continued on LIC 809-C) Knives and sharps are inaccessible to residents. Common area and dining room furniture were also checked. The common room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 73°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguishers are located throughout the building, observed to be full and last inspected on 11/01/2021. The residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are well lit. Residents have enough personal hygiene product and are purchased by the residents themselves. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 119.2°F. Towels and washcloths are not shared. There was enough clean linen available in the each of the residents rooms. LPA observed medication to be locked and inaccessible to residents, located in the Med Tech room. There is a complete first aid kits located throughout the facility (Med-Tech room, ED office, front desk, etc). Exit interview conducted. Copy of this report issued.