Routine inspection·August 30, 2022

At approximately 12:30PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Administrator, Maria Del Pilar De Olave. The visit is focused on the Infection and Control Practices of this facility. Upon arrival at the facility, LPA answered a standard COVID-symptom questionnaire. LPA could not check their temperature due to the facility needing a new thermometer. Administrator stated that they are getting a new thermometer today. LPA also viewed documentation of the Visitor Log which showed that facility keeps record of visitors at the facility and logs their temperature. LPA conducted a walk-through of the facility and observed the following: COVID-19 signs were observed at the entry way and throughout the facility. Hand-washing signs were observed in the bathrooms and at sinks. Staff were observed to not be wearing a mask but immediately put one on when LPA requested. The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has a cleaning and disinfecting schedule that occurs at least one time per day. Facility has at least a 30-day supply of Personal Protective Equipment (PPE) and medication for Residents. Staff and Residents are screened daily for COVID-19 symptoms and it is logged into facility binders. LPA and Administrator discussed N-95 Fit testing, Activities, and PPE. Facility has a plan in place if a staffing shortage were to occur. Fire extinguishers were last serviced March 2022. Facility has a Central Pull Fire Alarm system that is directly connected to the Fire Department. Smoke and Carbon Monoxide detectors were tested and operational. Continued on LIC-809C Continued from LIC-809 LPA requested the following documents to update facility file: Administrative Organization (LIC 309) Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610D) Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Liability Insurance Administrator to submit Administrator's Certificate (expires 12/07/2022) for facility file once renewal training is completed. Documents to be submitted to Community Care Licensing (CCL) by Friday, September 30, 2022 No Deficiencies cited during this inspection. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.