Routine inspection·January 20, 2023

Licensing Program Analyst (LPA) Hansen conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and met with staff Loida Montejo. Administrator/Licensee Leslie Wilson was unavailable at today’s inspection. There are 3 residents, one in the hospital currently, one resident has dementia, and none on hospice at this time. During facility tour on 1/20/2023 with staff; facility was found to be at a comfortable temperature. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 2/11/2022 at the time of the visit. Sample test of Smoke Detectors & Carbon monoxide detector were found to be operational during this visit. 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. Toxins are stored and locked under the kitchen sink and garage. Dangerous items were stored inaccessible to residents. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Residents’ medications are stored and locked in the medication file cabinet by the kitchen although there was over the counter medications on top of cabinet and undisposed of medications in large Ziplock bag in garage (see LIC 9102) for technical assistance. Facility has a 30-day supply of medication for residents. Facility understands that disaster drills must be conducted at least quarterly and records should be available for the Department to review, staff informed LPA they have not conducted a drill in a year (see LIC 9102) for technical assistance. Infection Control: Facility has submitted a mitigation program plan and infection control plan. Posters have been placed throughout of the facility. Facility has hand sanitizer available; visitors and staff before coming into work and temperature is checked and logged. Continue LIC 809-C Facility has PPE supply stored in the kitchen and garage. 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. LPA reviewed Licensing Information System (LIS) with designee who stated that is correct and updated at this time; no need to change any of the information. LPA advised facility to contact Local County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Staff had all PPE training required on file and have obtained N-95 fit testing. LPA was not presented with proof of current CPR & 1 st Aid certification for staff. One staff informed they need to renew and the other was unable to provide proof. (see LIC9102) for technical assistance. Administrator Certificate is for Leslie D. Wilson # 6020174740 Exp. 5/7/2024 All staff have received COVID booster vaccinations and work exclusively at this facility There were no deficiencies cited at this time. Department is requesting facility to submit the following updated documents by 2/10/2023: 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