Routine inspection·September 14, 2021

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual required inspection using the infection control tool. LPA arrived unannounced and met with Dhananjana Franklin, House Manager/Caregiver. The reason for the visit was explained. The Administrator, Simla Mehta, and Co-Administrator, Jennifer Bobadilla arrived later to assist with the visit. The Administrator Mehta's certificate expires on 11/13/2023. The facility is licensed to serve (15) residents, ages 60 and above, 11 may be non-ambulatory and 4 bedridden. The facility has an approved hospice waiver for (4) residents. At 1:35 p.m., LPA Chan and the House Manager toured the facility and observed/inspected the following: * There are 9 resident rooms and 3 bathrooms for resident use. Each bedroom is equipped with the proper furnishings. There is one bedroom and one bathroom for the live-in caregivers. * Signage are posted throughout the facility to promote hand hygiene. * Upon entry, routine symptoms screening is taken and documented. There is a designated outdoor area for visitation. * The hot water temperature was measured within the range of 105 -120 degree F. * Medications were reviewed for 5 residents and are being administered as prescribed. * Staff indicated they are cleaning and disinfecting the facility multiple times a day, including mopping the floors. * Staff were all wearing face coverings. * Cleaning supplies and disinfectants were locked and stored away, inaccessible to residents. * Adequate supplies of 2 day perishable and a week of non-perishable foods were observed. Extra food supplies are stored in the garage storage room. There are no deficiencies observed during today's visit. An exit interview was conducted and a copy of this report along with the appeal rights were given to the Administrator.