Routine inspection·November 8, 2022

At approximately 1:15PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required - 1 Year Visit, and met with Administrator, Momo Duoa, and Executive Director, Shannon Brown. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival at the facility, LPA had their temperature checked and logged. 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. All staff present were observed to be wearing a mask. 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 once per day. Facility has at least a 30-day supply of Personal Protective Equipment (PPE) and medication for Residents. LPA and Administrator discussed the following: Vaccinations, activities, staffing, incident reports. Facility has a plan in place if a staffing shortage were to occur. Facility submitted their Mitigation/Infection Control Plan to Community Care Licensing (CCL). Fire extinguishers were last serviced January 2022. Facility had fire inspections conducted on September 22, 2021, and November 1, 2022 where smoke and carbon monoxide detectors were tested and operational. The last facility disaster drill was conducted October 20, 2022. 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) Updated Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Liability Insurance Surety Bond Documents to be submitted to CCL by due date of Tuesday, November 29, 2022. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.