Routine inspection·April 19, 2022

Licensing Program Analyst (LPA) Abeye Duguma met with Zoey Gevorkian 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 9:45am 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. The facility is fire cleared for six (06) non-ambulatory of which one (01) may be bedridden and a hospice waiver for six (06). The facility is currently occupying five (05) residents. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has sufficient stock of PPE. The facility has six (06) bedrooms; all bedrooms were properly furnished and supplied with appropriate bedding and linens. Rooms observed to have bedspreads, sheets, pillowcase, mattress pad, and blankets. There were sufficient linens observed and available. There are four (04) bathrooms; all were clean, with soap, towels, grab bars, and non-skid mats. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility has a gated and locked swimming pool. The laundry detergents, cleaning agents and other toxins are stored in a locked kitchen cabinet. Food Service/Kitchen area 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. Knives and sharps are observed to be locked in a cabinet under the sink, inaccessible to residents. Living/common and dining room furniture were also checked. The living/common room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 70°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. (continued on LIC 809-C) Fire extinguisher is located in the bedroom, observed to be full and last inspected on 12/22/2021. Staff rooms were observed to be locked and located near the dining area. No medications are observed in the staff room. The residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 116.8°F. Towels and washcloths are not shared. LPA observed medication to be locked and inaccessible to residents, located in the kitchen cabinet. There is a complete first aid kit located near the foyer. Exit interview conducted. Copy of this report issued.