Routine inspection·October 31, 2022

At approximately 9:15AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required - 1 Year Visit Inspection and met with Administrator, Ana Bautista. Facility currently has 5 residents, and serves residents with dementia. Facility has a plan of operation for dementia care and programming. 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 answered a standard COVID-symptom questionnaire. 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. Staff and Residents are screened daily for COVID-19 symptoms and it is logged into facility binders. LPA and Administrator discussed the following: Booster Shots, activities, staffing, incident reports, and training. 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 extinguisher was last serviced April 2022. Smoke and carbon monoxide detectors were tested and operational. The last facility fire and evacuation drill was conducted August 24, 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) Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Control of Property (Renewal of Lease) when applicable Liability Insurance Documents to be submitted to CCL by due date of Wednesday, November 30, 2022. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.