Routine inspection·June 3, 2021

Licensing Program Analyst (LPA) Jennifer Semin arrived at the facility unannounced after completing a COVID-19 Risk Assessment Screening for the facility via telephone. LPA met with Hemalata Bansode and advised of the purpose of the visit, and that the annual inspection will be limited to Infection Control only. Below is a summary of what was observed: LPA went over COVID-19 best practices for infection control and prevention with Ms. Bansode who is successfully incorporating the facility's Mitigation Plan. Residents have hand sanitizer available to them and the bathrooms were stocked with hand soap and paper towels. LPA observed the facility to have multiple postings throughout the facility for cough etiquette, proper hand washing procedure, social distancing, and emergency contact information for local fire department has been updated. LPA requested to inspect the facility's Personal Protective Equipment (PPE) supply, which was located near the single-entry point for convenience and stores additional PPE at the office. LPA observed a 30-day supply of gloves, face shields, gowns, surgical masks, N95 masks, disinfectant and hand sanitizer. LPA and Ms. Bansode discussed creating a box, or similar, to have a supply of PPE ready that would be dedicated for isolation room, along with a trash can to put outside of an isolation room. LPA inquired as to if staff have been fit tested for N95 masks, and Ms. Bansode stated the staff have not been fit tested. LPA will issue a Technical Assistance Advisory Note for staff not being fit tested for N95 masks. LPA will not be issuing a deficiency for this item as the facility does not currently having any COVID-19 positive residents, and N95 masks only needing to be worn when a resident is COVID-19 positive or under observation while awaiting test results. Additionally, residents have been vaccinated and are practicing other COVID-19 precautions, which minimize the risk of them contracting COVID-19. LPA provided Ms. Bansode with the Provider Information Notice (PIN) PIN-21-10-ASC which contains resources for getting staff fit tested for N95 masks. An exit interview was conducted where this report was discussed and provided to Ms. Bansode along with a copy of PIN 21-10-ASC and LIC9102 TA Advisory Note.