Routine inspection·February 14, 2023

Licensing Program Manager (LPM) Ulysses Coronel and Licensing Program Analyst (LPAs) Antonine Richard and David Espana conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA was met by Administrator Michelson Candice and the purpose of today’s visit was explained. The facility is licensed to serve age range 60 and over. approved for 6 non-ambulatory, of which 1 may be bedridden. approved hospice waiver for 1. There are currently 2 residents in placement . 1 of 2 residents is non-ambulatory. The facility is a single story structure located in a residential neighborhood. It consists of the following: 3 bedrooms, 2 bathrooms, family room/dining room, kitchen, living room, shaded area, indoor and outdoor activity area, laundry room and detached garage. LPA and staff toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. All client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The hot water temperature measured 116.2 F.A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. The kitchen was inspected and there is a enough perishable and non-perishable food available which is stored properly. Fire extinguisher was charged, smoke detectors and Carbon Monoxide were operable. During the visit, LPA observed the facility infection control practices. LPA observed staff and residents were wearing face coverings. LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. During today’s visit there were deficiencies observed. LPA did not observe observed the facilities 30-day supply of Personal Protective Equipment (PPE). LPA did not observe screening protocols for visitors, staff and residents. Storage areas for cleaning, toxins, and sharps were accessible to clients. LPA Observe the metal gate on the left side of the house is an disrepair. LPA did not observe required COVID-19 related postings throughout the facility. LPA observed only 4 beds present at the facility. Exit interview held, plans of corrections were developed. A copy of the report and appeals rights was provided to Candice Michelson, administrator.