Routine inspection·October 21, 2021

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection with the focus of the infection control domain. LPA arrived unannounced and met with Staff, Phyllis Lee. The purpose of the visit was explained. The facility is licensed for 6 non-ambulatory residents, age 60 and over. There is an approved hospice waiver for 2 residents. LPA toured the facility with the staff and observed the following: * Upon entry, there was a station set up to take visitors' temperature and for visitors to take the screening questionnaire. * There is one entry point for staff and visitors. * There was a sufficient supply of 2 -day perishable and a week of non-perishable foods in storage. * Residents' rooms have the required furnishings. * Knives and sharps are stored and locked in the kitchen area under the sink. * Medications are locked and centrally stored. Medications were reviewed for 3 residents and a 30-day supply was maintained at the facility. * Visitation area is set up outdoor by the main entrance. * Staff were wearing face coverings. * Extra PPE supplies are stored in the living room closet. The following technical advisories were provided on the LIC9102 form: * Postings to promote hand washing, cough/sneezing etiquette, and physical distancing. * N95 Fit testing No deficiencies were observed during the visit today. An exit interview was conducted with Staff and a copy of this report along with appeal rights were provided.