Routine inspection·December 19, 2022

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced visit to conduct the required annual inspection focused on Infection Control Domain. LPA met with Operations Manager Michael Forsgren and the purpose of the visit was discussed. On todays visit LPA followed the Infection control domain, toured the physical plant, reviewed six (6) resident and four (4) staff files, and the medication records for six (6) residents. LPA Villalobos discussed infection control practices with staff, toured the facility inside and out between. The facility physical plant consists of a two story building structure that contains the following: First floor consists of resident rooms with individual bathrooms, 1 living room, Dining Rooms, courtyard, 3 offices, medication room, kitchen, and laundry area. Physical plant inside and outside is clean, sanitary and in good repair. The facility second floor consists of the following: resident bedrooms with individual bathrooms, laundry room, outdoor porch seating area, and Activity room. The following was observed: Rooms have required furniture and supplies. Facility had an area with locked cabinet for medications. Facility is clean and in good repair. Water temperature met Title 22 Regulations measuring between 105-120 F. .Cupboards, freezer, stove, microwave, refrigerator and counters are clean. Bathrooms for the above mentioned rooms were observed and meet title 22 regulations. There was a 7 day supply of non-perishables available and a 2 day supply of perishables available. Resident records inaccessible to residents in care. Required postings were observed. First Aid Kit and manual were observed. Smoke detectors and carbon monoxide detector operate properly and fire extinguishers are properly charged. Working washers and dryers. Working telephone. There are no bodies of water located on the premises. Adequate seating in common areas for licensed capacity. Furniture in all facility rooms appropriate, clean and in good repair. There is an outdoor activity space/ patio with a shaded area and furnished for outdoor use. LPA collected Infection Control plan and proof of Liability Insurance at the time of visit. Visit was completed using the Infection control inspection tool. No deficiencies were cited on todays visit. Exit interview was conducted and a copy of report was provided to Operations Manager Michael Forsgren.