Routine inspection·August 6, 2022

On 08/06/22, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit with a primary focus on Infection Control measures using the CARE Inspection Tool. LPA met with administrator Elsa Roman and explained the purpose of today’s visit. The facility is licensed to operate for (6) non-ambulatory of which (1) may be bedridden elderly residents ages 60 and above. The facility is approved for (2) hospice residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) residents' rooms, two (2) common bathrooms, a living area, a dining area, a kitchen, and an outside covered patio area. LPA toured the physical plant. There were no obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations and were operational. The water temperature measured 110.6 F. A comfortable temperature of 74 degrees was maintained in the facility. LPA observed the facility to be appropriately furnished at the time of the visit. Storage areas for personal hygiene and objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. The facility has (1) fire extinguisher that is charged, and smoke detectors operable. A working landline telephone remains available. The medication administration record (MAR) was reviewed and found to be accurate and maintained in order. Evaluation Report continues on LIC 809-C INFECTION CONTROL: During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed staff wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A review of staff tests and residents' vaccination along with daily temperature checks were conducted. The facility has an approved Mitigation Plan Report on file with CCLD. The facility has submitted Infection Control Plan for 2022 with CCLD. DEFICIENCIES: LPA identified at 1:51 pm knives under the kitchen sink were exposed in an unlocked cabinet. At 1:52 pm LPA identified (2) knives inside the dishwasher. At 1:54 pm, LPA identified cleaning solutions and other hazardous materials under bathroom sink #2 in an unlocked cabinet and accessible to residents in care. Deficiencies are issued and an exit interview is conducted with Elsa Roman. A copy of this report is provided along with the appeal rights.