Routine inspection·November 29, 2022

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with staff Nelia Romero and explained the purpose of the visit. Assistant Administrator Zoltan Kiss arrived shortly after and was explained the purpose of the visit. There is one (1) resident over the age of 60. The facility is a single story home located in a residential neighborhood that is licensed for 6 non- ambulatory residents, of which 1 may be bedridden. A hospice waiver for 1 and Dementia waiver is in place. The last fire drill was conducted on 10/2/2022. Administrator certificate expires 5/10/2024. OBSERVATIONS The facility consists of 3 resident bedrooms, 2 staff bedrooms, living room, dining room, kitchen, laundry room, 3 bathrooms, backyard patio area, detached garage, and an ADU (Additional Dwelling Unit) in the rear of the property. COVID-19 Infection Control signs were observed in the entrance, common areas, hallways, and bathrooms. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. A visitor screening station is in the entry. It includes a thermometer, hand sanitizer, masks, and gloves. Personal Protective Equipment (PPE's) was observed. The residents do not wear a face mask due to cognitive impairment. The private room has been designated as a COVID-19 isolation room if needed. One (1) month supply of centrally stored medications was observed. Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed. Criminal Background Clearance was checked. No deficiencies were observed. Exit interview was conducted with Assistant Administrator Zoltan Kiss. A copy of the report was provided.