Routine inspection·July 13, 2022

Licensing Program Analyst (LPA) Shobhana Frank made an unannounced visit to the facility today to conduct required 1 year inspection. During today’s visit, LPA met with Licensee Brevet Dao and explain the purpose of today's visit. LPA Frank toured the facility, inspected resident rooms and bathrooms. There are 5 residents residing in the facility and no active COVID-19 cases. LPA Frank reviewed centrally stored medications and records, reviewed food services, and inspected the kitchen. In addition, LPA Frank tested the hot water temperature, which measured 105 .8 degrees F in resident bathroom. Resident areas were noted to be a comfortable temperature. Smoke detectors and carbon monoxide detectors were tested and found to be operational. The facility also has fire extinguisher that was mounted and charged. LPA Frank confirmed food supply 2 day supply of perishables and 7 day supply of non-perishable food is available for the number of residents present. Hygiene supplies and supply of linen were observed in quantities for the number of residents in care. LPA observed locked areas for toxins and hazardous items. Medication were observed locked in cabinet. LPA observed COVID - visitation station equipped with hand sanitizer, thermometer, Gloves, visitors log, COVID posters throughout the facility. LPA Frank reviewed : 1.) Designation of Administrative Responsibility (LIC308) 2.) Personnel Report (LIC500); 3.) Emergency Disaster Plan (LIC610E); 4.) LIC 9020A Client Roster; LIC 808) Mitigation Plan; Current Liability Insurance, Infection Control Plan. Based on the observations made during today’s visit, the facility bathroom, toilet, kitchen sink and kitchen counter is unkempt, which poses an possible health, safety or personal rights risk to persons in care. An exit interview was conducted with the licensee, A copy of LIC 9102 Technical Assistance and LIC 809 was provided.