Routine inspection·September 20, 2021

Licensing Program Analyst (LPA) Fernandes-Goes conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and met with staff Catalina Sanchez. Facility has 5 residents present with 1 resident under Hospice care at this time. Facility offers activities cards, reading, exercises, outside walk, and etc. During facility tour on 9/20/2021 with staff Catalina Sanchez, facility was found to be at a comfortable temperature. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Sample test of Smoke Detector & Carbon monoxide detector were found to be operational during the 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. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Facility understands that hot water temperatures must measure within Title 22 acceptable regulations of 105 to 120 degrees F. Infection Control: Facility has submitted a mitigation program plan that has been approved. Facility has posters that placed at facility. At this time facility is planning to have at entrance a table with hand sanitizer and other items designated for visitors and staff before coming into work. Facility doesn’t have enough PPE supplies stored in the facility. Facility has admitted new residents since COVID-19. Residents medications are stored and locked in a locked medication closed in the entrance of the facility. Facility has a 30-day supply of medication for residents. Residents are not wearing masks inside the facility, however; staff stated that they are sometimes able to wear masks when going on outings. All staff had masks on during this visit. Continued LIC809-C In addition, facility has a designated area for visitors which are being allowed for visits. Residents also have available video and telephone calls when contacting with family members and others. Staff had all PPE training required on file and facility is working towards obtaining N-95 fit testing. In addition, LPA advised facility to contact local County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility understands that unvaccinated staff must be tested once a week if PCR and vaccinated staff doesn’t need to be tested at this time if staff is able to show proof of vaccination which copy of vaccination card must be kept on facility file for staff at this time according with PIN 21-32 & PIN 21-32.1-ASC: UPDATED FACILITY STAFF TESTING AND MASKING GUIDANCE FOR CORONAVIRUS DISEASE 2019 (COVID-19). In addition, LPA had a discussion with administrator regarding visitation guidelines per PIN 21-40-ASC: UPDATED STATEWIDE VISITATION WAIVER, AND TESTING AND VACCINATION VERIFICATION GUIDANCE FOR VISITORS RELATED TO CORONAVIRUS DISEASE 2019 (COVID-19) . This visit will need to be continued at another day. LPAs reviewed Licensing Information System (LIS) with staff who stated that is correct and updated at this time. No deficiencies cited during this inspection. Department is requesting the following updated documents to be submitted to CCLD by 9/27/2021: LIC 308 Designated Administrator LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 610E Supplemental Emergency Disaster Plan for RCFE LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Liability Insurance