Routine inspection·October 18, 2022

On 10/18/2022, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility unannounced on to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with staff who LPA asked to contact Administrator to be present at the facility. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted licensee and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. LPA was not screened by facility staff upon entering the facility. LPA toured the interior and exterior of the facility together with Administrator to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. LPA observed (6) residents to be present at the facility, and (0) residents to be on hospice services. LPA advised Administrator to screen all visitors for symptoms of COVID-19 upon entry. LPA advised facility to have hand washing posters in the bathrooms. LPA observed Administrator Certificate to be up to date. LPA observed the fire extinguisher to be last serviced 11/2/2020. LPA informed Administrator that it needs to be serviced every 12 months. LPA observed (3) individuals in the facility without a mask. LPA informed Administrator that staff and visitors are mandated to wear mask while residents are in care. At this time, LPA obtained copies of Administrator Certificate, LIC 500 and current liability insurance. LPA requested a copy of LIC 308 (Designation of Responsibility) to be emailed to LPA by 10/25/2022. As a result of today's inspection, deficiencies were observed and cited. Please see attached LIC 809-D and LIC 9102. Exit interview conducted and copy of report and appeal rights left at the facility.