Routine inspection·November 24, 2021

On 11/24/2021, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with staff Naumati Iosefo-Lead Caregiver and explained the purpose of today’s visit. The facility is an RCFE licensed for five (5) non- ambulatory clients and one (1) bedridden. The facility is a one-story structure located in a residential neighborhood. It consists of the following: Five (5) bedrooms, including one (1) staff bedroom, two (2) full bathrooms, living room, dining room, and kitchen. A closet/storage space is located in the hallway. A two (2) car attached garage is located in the front of the property and a backyard with shaded area and seating area with table. LPA and staff toured the physical plant. There were no bodies of water or obstructions on the premises. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. 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. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Cleaning supplies, toxins and sharps objects are stored in locked kitchen drawers/cabinets locked and not accessible to clients. The kitchen was inspected and there is a 2-day supply of perishable and a 7-day supply of non-perishable food available, maintained properly. Fully charged fire extinguisher was found in kitchen. During the visit, LPA observed the facility infection control practices. LPA observed screening protocol for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, all mandated inspection control posters were posted. Deficiencies cited on case management. Advisories are on attached 9102 An exit interview was conducted, and a copy of this report was provided to Naumati Iosefo, lead staff.