Routine inspection·August 6, 2021

Licensing Program Analyst (LPA) LaQueena Lacy arrived at the facility at 8:30am to conducted a One (1) year Required Infection Control visit. LPA meet with the administrator Lisa Villasenor and explained the purpose of this visit. A tour of the physical plant was conducted at 9:18am and the following was observed: The facility has one main entrance being used, there are required Covid-19 prevention signage (hand washing, coughing etiquette and physical distancing) posted and hand sanitizers wall mounted throughout the facility. The PPE screening station is located at the receptionist front desk office equipped with sufficient PPE readily accessible a thermometer, gloves, mask and sign in sheet at the time of visit. Hand sanitizer is located at the entrance door way. Visitors are allowed by appointment in the facility, visits may occur in residents rooms, in the common area lobby located at the entrance of the facility or the outside shaded patio area with benches for seating. The facility maintains a comfortable temperature of 77 degrees. At 8:42am LPA observed staff Alvin spraying a mist from a machine into to the air and door handles and other high touch services. Administrator Lisa informed me that it's a aromatic machine that dispenses a chlorinate which is a tablet that is dropped into water that is all natural and is a disinfectant spray. The procedure is done every three (3) hours to four (4) hours. Facility currently have 17 hospice residents with a waiver for twenty(20). Residents Rooms: At 9:25am between 9:58am LPA observed nine(9) rooms 112,121, 135, 143, 152, 172, 193, 206 and 210 on the first floor in the assisted living unit and memory care unit. All bedrooms observed to be clean and neat and have sufficient lighting and properly furnished with appropriate bedding and linens. Pull cords were tested in room 112 at 9:48am, 172 at 9:34am, staff Patty responded within one(1) to (2)two minutes. The water temperature ranged from 108.9 to 119.6. Memory care unit has an activity room with access to outside which is dedicated to the memory care unit only. Paper towel and soap dispensers are located in each residents bathroom. Continued on LIC 809C Medication: At 9:50am LPA observed the medication room located in the memory care unit to be locked and inaccessible to residents. The facility has three (3) First Aid kits that are kept in the medication room. Kitchen: At 10:13am LPA observed the kitchen to be clean and an adequate supply of perishables and non-perishable food located in the fridge, freezer and pantry. Food was properly labeled and stored. Food storage and preparation areas are clean and inaccessible to pests. The emergency food is stored in the pantry area located in the kitchen. Trash cans were observed to have tight fitting lids. Sharps are stored in the kitchen inaccessible to residents, staff is always present, and the kitchen is never left unattended and is locked at 7pm to prevent access to residents. Dining room and common areas: At 10:18am LPA observed a beauty salon which was locked and inaccessible to residents located down the hall from the laundry room on the basement level. LPA observed all common areas to have sufficient lighting, tables and chairs for seating. The dining room is located on the basement level near the kitchen. At 10:22am LPA observed a patio area adjacent to the dining room which has a walkway beside the building that led to an outdoor patio shaded area equipped with tables and chairs for lounging, which was observed to clean and clear of debris and obstruction. Activity room two(2) labeled Therapy Center is located on the basement level to assist with physical therapy for residents is new program as of June 21, 2021. The facility has two(2) common bathrooms located on the first floor. Laundry Room: At 10:25am LPA observed the laundry room located on the basement level observed to be clean and clear from obstruction. It has a "push system" located on the wall which is a laundry system that dispensing laundry soap and softener, which is located behind the washing and dryer machines in a room LPA observed to be locked and inaccessible to residents. Storage Rooms: LPA observed storage room one (1) located in memory care unit observed to be locked and storing activity supplies. Storage room two(2) located on the basement level near the laundry room and beauty salon observe to have extra blankets, linens and towels. Storage room three(3) observed to be locked with mops and buckets and another "push system" located on the wall that dispense cleaning solutions next door to the laundry room. Fire Extinguishers observed to be wall mounted and located through out the facility first floor, assisted living unit, memory care unit and basement level where the kitchen, dining, laundry and salon room are located. The service tag is dated July 6, 2021 through August 05, 2021. At 10:43am the fire alarm system was tested and observed to be working, it is hard wired and have a water sprinkler system. PPE is stored in the health care director room, down the hall near room 189 labeled emergency exit and in the maintenance room located in the garage, the facility has more then a 30 day supply on hand. The facility has an approved mitigation plan on file. Exit interview conducted, copy of report issued.