Routine inspection·April 13, 2022

Licensing Program Analyst (LPA) Melody Brown arrived at the facility 04/13/2022 at 1:20 PM unannounced in order to complete the facility's Annual Inspection. LPA Brown met with Administrator Raymond Chu 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: Infection Control: LPA Brown went over COVID-19 best practices for infection control and prevention with Administrator Chu. Administrator Chu reported that Mitigation Plan was submitted 03/05/2021. LPA Brown observed the facility having Covid-19 signages throughout the facility for proper hand washing procedure, social distancing. LPA Brown toured the facility's resident bedrooms and bathrooms and observed that both resident bathrooms have paper towels and hand soap. LPA Brown requested to inspect the facility's Personal Protective Equipment (PPE) supply. LPA Brown observed the facility to have a sufficient supply of sanitizer, gloves, masks, and face shields/goggles and isolation gowns. LPA Brown went over the various recommended training for facility staff with Administrator Chu in relation to COVID-19 and Administrator Chu informed LPA Brown that all staff are trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing of PPE. LPA Brown inquired as to if staff have been fit tested for N95 masks, and Administrator Chu informed LPA Brown that at this time staff have not been fit tested. LPA Brown will be issuing a deficiency during today's inspection for staff not being fit tested for N95 mask because the facility recently had a covid positive resident last 01/16/2022 and N95 mask needs to be worn when a resident is COVID-19 positive or under observation while awaiting test results. Additionally, all residents and most staff have been vaccinated and are practicing other COVID-19 precautions, which minimize the risk of them contracting COVID-19. **** Continuation in LIC809C **** LPA Brown will be providing Administrator Chu with the information for Provider Information Notice (PIN) PIN-21-10-ASC which contains resources for getting staff fit tested for N95 masks. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE and overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and their residents, when and how to isolate/quarantine residents, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to monitor their residents regularly for any changes in condition and to subsequently notify the resident's physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses. During the visit, LPA Brown requested staff vaccination records and on 04/13/2022 at 02:00 PM, LPA Brown observed no vaccination record for Staff 5 and no exemption letter on staff file. Also, Staff 3 and Staff 4 do not have their booster information or booster exemption on file at the facility. LPA Brown will be issuing a deficiency for failure to keep records of Worker’s Vaccination/Exemption which can pose potential risk to residents in care. An exit interview was conducted with Administrator Raymond Chu and a copy of this report (LIC809), LIC 809D and Appeal Rights were discussed and provided.