Routine inspection·October 14, 2022

On 10/14/2022, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and was greeted by staff Edwin Lopez-Taitano. Administrator Henri Van Meines was contacted and arrived for the inspection. The facility is a 6 bed one story home that currently provides care for 5 residents, 2 of which are on hospice and some with a diagnosis of dementia. LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with Administrator and staff; 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 12/1/2021 at the time of the visit. Smoke and carbon monoxide detectors were found throughout the facility are connected, tested and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods properly stored as required by Title 22 Regulations with balanced meals and alternative meal options for residents. LPA conducted a sample file review and found all reviewed staff to have current 1st Aid & CPR training certification on file. Medications and facility records are located in the kitchen with medications secured in designated cart. LPA observed an oxygen tank located in resident bedroom with appropriate signage posted for required safety precautions. Toxins are stored in a locked facility laundry room and maintenance closets which were found to be secured upon observation. There was a supply of hygiene products and paper products available for resident use. All resident bedrooms have lighting & appropriate furnishings. Continued onto LIC809-C Infection Control: Facility has submitted an Infection Control Plan to CCLD for review. All residents and staff are vaccinated with no symptoms. Posters have been posted throughout the facility for staff and residents ensuring COVID procedures. Facility has a station at main entrance for screening, hand sanitizer and other items designated for visitors and staff. Staff and residents are observed for symptoms and temperature based on change of condition. No deficiencies cited during the inspection. LPA requested the following documents be sent to CCL by COB 10/28/2022: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility resident’s/Resident’s Copy of Administrator Certificate(s) Copy of Liability Insurance