Routine inspection·February 10, 2023

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met Rose Mead, Administrator, and staff, Rowena Tirasol. LPA explained purpose of inspection. LPA observed (1) resident sitting outside on the front patio and (3) residents to be in their rooms at the start of the inspection. The facility is licensed for (5) non-ambulatory residents, (1) ambulatory and has a hospice waiver for (3). Currently, there are (3) residents on hospice. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols, wore a surgical mask and was screened per Covid-19 precautionary measures upon entering the facility. LPA and Administrator toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms (1) vacant shared resident bedroom, (2) resident bathrooms, (1) staff room, kitchen and laundry area, and office area. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps, medications and toxins in the kitchen/laundry area. LPA observed the inside temperature to be 71*F. LPA observed games/activities on site. The fire extinguisher was last serviced on 11/14/22. Facility conducts quarterly fire drills. All staff are cleared and associated to the facility. Discussed vaccination status of residents/staff. Booster flyer was provided. LPA observed multiple Covid posters throughout as well as other required postings. LPA observed (2) unlocked gates from the outside patio and also covered seating. Administrator to ensure any donations being stored outside are picked up timely. LPA observed sufficient incontinent and PPE products on hand. Discussed PIN 23-02 issued 2/9/23. LPA observed RCFE Administrator certificate #6014576740-exp 3/18/24. LPA reviewed (2) resident files and (1) staff file and found them to be complete with current documentation, including training, completed through out approved outside vendor. LPA observed a completed Infection Control Plan and Monkey Pox Plan, also obtained through an approved outside vendor, on file. Updated copy of license printed to reflect hospice waiver for (3). LPA requested an updated copy of the LIC308, LIC500 and current liability insurance be provided by 2/17. There are no deficiencies issued during today's inspection. Exit interview. Copy of report provided.