Routine inspection·June 25, 2021

Licensing Program Analysts (LPA) Elizabeth Irra conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPAs met with Facility Administrator and explained the purpose of the visit. COVID-19 Infection Control Practices (including signs) were observed at the entrance of this home, in all common rooms and hallways. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Facility has four (4) designated isolation rooms available if a COVID-19 positive case should arise (isolation wing). Each room has their own PPE supply cart, trashcan with lid and isolation signage on the door. Medications for (4) Residents were reviewed. PPE supplies: (4) different locations with PPE supplies- near medication room, storage room, north wing and south wing. Additionally, incontinence supplies and cleaning supplies were observed. Beds: Beds have been moved according to guidelines. However, rooms were observed to have a separation between beds which consisted of a rod holding removable curtains to prevent COVID transmission. Administrator will have these items removed as the facility has a designated wing for COVID. Technical Advisory Note provided. Staff responsible for direct care and supervision were observed wearing masks. Food: Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed. Food supply is stored and prepared in the kitchen located next to this building. Per Facility Administrator, meals are still being offered in a staggered manner. Dinning area: (2) residents per table. in-room food trays are also being provided. Residents were socially distanced according to local public health guidelines. Per Administrator, per Pasadena Public Health Department (PPHD) requires a weekly report each Monday and a line-list is sent daily (including weekends). There are no deficiencies noted. Exit interview conducted, a copy of this report and Appeal Rights were provided to Facility Administrator