Routine inspection·September 22, 2022

Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 09/22/2022 to conduct a Required - 1 Year inspection. This inspection was focused on the infection control practices and procedures of this facility. LPA was initially greeted by staff. Administrator, Francisco Roa arrived shortly. LPA toured building and grounds which were clean and in good repair. Exits and walkways were free from obstructions. Facility has a total of 4 bedrooms, 2 of which are shared. There are currently 4 residents in care. Current census allows for isolation of residents if necessary. Resident bathrooms have necessary grab bars and non-slip mats. Resident bedrooms were furnished per regulation. LPA observed operational CO and smoke detectors throughout the facility. Facility had a sufficient supply of perishable and non-perishable food. Toxins were kept locked and secured. Medications were centrally stored and inaccessible to residents in care. Facility had a supply of extra linens and towels for residents. LPA reviewed 3 staff files and 3 resident files. LPA and administrator discussed ongoing training requirements for staff. LPA and administrator discussed when it is necessary to request updated physician's reports. All staff and residents are fully vaccinated. Administrator is working with public health to schedule the third booster shot. LPA is requesting the following documents be submitted within 30 days of the inspection: LIC 500 Personnel Report LIC 610 Emergency Disaster Plan LIC 9020 Resident Roster LIC 308 Designation of Facility Responsibility Evidence of Liability Insurance No deficiencies cited during today's inspection. Exit interview conducted with administrator and a copy of this report printed for the facility.