Routine inspection·August 2, 2022

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with caregiver Crispin Dizon and advised him of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. LPA Colvin additionally went over the Infection Control items with Administrator Gerlita Higa via telephone, as the Administrator was unable to make it to the facility. Below is a summary of what was observed: Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with Administrator Gerlita Higa, who LPA Colvin found to be successfully incorporating the several aspects of the infection control, despite not having a Mitigation Plan on file. LPA Colvin inquired about if there was a copy at the facility for LPA Colvin to review (as there is no evidence that one has been submitted to Licensing) and the Administrator stated that there is not. LPA Colvin will be issuing a Technical Advisory Note for the facility not having a Mitigation Plan. LPA Colvin will not be issuing a deficiency as the Mitigation Plan request/requirement is outdated, and facilities are now being advised to submit an Infection Control Plan. Residents have hand sanitizer available to them, and 1 of 2 resident bathrooms were stocked with hand soap and paper towels. LPA Colvin observed the bathroom in the back hallway to have hand soap, but no paper towels. LPA Colvin will be issuing a Technical Assistance (TA) Advisory Note during today's inspection for the lack of paper towels as well as a deficiency for the common use of washcloths or towels, as LPA Colvin observed hand towels to be handing in the bathroom by the sink. It is a standard Title 22 Regulation that common towels are not be used. Deficiency cited. While touring the facility, LPA Colvin observed postings throughout the facility for cough etiquette, social distancing, and infection control. LPA Colvin requested to view the facility's PPE supplies (gloves, masks, and sanitizer, and isolation gowns), which was located in the locked hallway closet. LPA Colvin observed the facility have an adequate supply of PPE. LPA Colvin went over the various recommended training for facility staff with Administrator Gerlita Higa in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE. LPA Colvin inquired as to if staff have been fit tested for N95 masks, and Administrator Gerlita Higa confirmed that this has been done with the assistance of the local Public Health Department.. LPA Colvin observed 1 of 1 staff present (caregiver Crispin Dizon) to not be wearing any type of face covering. At this time, face coverings are still required in all residential facilities. LPA Colvin will be issuing a TA Advisory Note for 1 staff not wearing a face covering. LPA Colvin observed a sign-in sheet at the front door of the facility, and confirmed that visitors are signing in to the facility, however, LPA Colvin was not able to confirm that they are being screened for symptoms, as LPA Colvin was not screened, there is no thermometer at the entrance of the facility or near the sign-in log, and there is no recorded temperature for the visitors on the sign-in log. LPA Colvin will be issuing a Technical Advisory Note for facility staff not screening visitors prior to entry. An exit interview was conducted with caregiver Crispin Dixon, and a copy of this report, LIC809D, appeal rights, and LIC9102 TA Advisory Notes were provided.