Routine inspection·February 4, 2022

Licensing Program Analyst (LPA) Fernandes-Goes conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and met with Administrator Cynthia Virata. There were 34 residents with 7 under hospice at facility. Facility has activities planned for residents during the day. LPA arrived at the facility and had her temperature checked and logged into a log. During facility tour on 2/4/2022 with administrator; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 1/2022 at the time of the visit. Sample test of Smoke Detectors & Carbon monoxide detector were found to be operational during this visit. Fire sprinklers are inspected annually, and inspection records are current with the last inspection being conducted on 12/9/2021. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Facility has residents' with a special diet which is posted in the kitchen board w/ pictures. In addition, serving trays have residents' names with specific guidelines according with their needs. Toxins are stored in a locked linen, housekeeping area and outside storage. Dangerous items were stored inaccessible to clients. There was a supply of cleaners, hygiene products and paper products available for clients. All resident’s bedrooms have lighting & appropriate furnishings. Disaster drills are being conducted quarterly with records for last fire drill on 11/10/2021. Infection Control: Facility has submitted a mitigation program plan that has been approved. Some posters have been placed at entrance and bathrooms. Facility has hand sanitizer available; visitors and staff before coming into work have temperature checked. Continue 809-C Facility has PPE supply stored in office, beauty salon, med tech room, and basement. There has been new staff hired and new resident’s admission since COVID. Residents’ medications are stored and locked in the medication room. Facility has a 30-day supply of medication for clients. Residents are not wearing masks inside the facility, however; staff stated that they are able to wear masks when going on outings. All staff had masks on during this visit. In addition, facility has a designated area for visitors which are being allowed. Residents have also available virtual and telephone calls when contacting with family members and others. Staff have had all PPE training required on file and have acquired N-95 fit testing for staff. There were no deficiencies cited at this time. Department is requesting facility to submit the following update documents by 2/11/2022: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 610E-S Supplemental Emergency Disaster Plan for RCFE LIC 9020 Register of Facility Client’s/Resident’s Copy of Certificate of Liability Insurance Copy of Administrator Certificate