Routine inspection·December 1, 2022

At approximately 8:50AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Executive Director, Susan Edwards, and Health and Wellness Director, Victoria Mozaffari. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. 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 twice per shift. 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 kiosk system. LPA and Administrator discussed staffing, N-95 fit-testing, activities, PPE, and training. Facility has a plan in place if a staffing shortage were to occur. Facility has submitted their Mitigation/Infection Control Plan to Community Care Licensing (CCL). Fire extinguishers were last serviced April 2022. Facility has a Central Pull Fire Alarm system that is directly connected to the Fire Department. The last facility fire and evacuation drill was conducted in November 2022. Continued on LIC-809C Continued from LIC-809 LPA and Executive Director discussed paperwork to be submitted to CCL. Executive Director is to be the Administrator on File. LPA requested the following documents to update facility file: Administrator Documents LIC 308 (Designation of Facility Responsibility) Active and Current Administrator Certificate First Aid Certificate Administrator Resume LIC 500 (Personnel Report) LIC 501 (Personnel Record) LIC 503 (Health Screening Report - personnel) Proof of TB test LIC 9182 (Criminal Record Exemption Transfer Request) LIC 508 (Criminal Record Statement) Copy of Driver's License or Passport that is not expired Facility Documents Administrative Organization (LIC 309) Emergency Disaster Plan (LIC 610D) Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Liability Insurance Administrator and Facility Documents to be submitted to CCL by due date of Friday, December 29th, 2022. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.