Routine inspection·February 17, 2022

Licensing Program Analyst (LPA) Melody Brown arrived at the facility 02/17/2022 at 10:00 AM unannounced in order to complete the facility's Annual Inspection. LPA Brown met with House Manager Patricia Roggenbuck and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Administrator Christopher Tanabe was contacted and later arrived during the visit. Below is a summary of what was observed: Infection Control: LPA Brown went over COVID-19 best practices for infection control and prevention with House Manager Roggenbuck and Adinistrator Tanabe and they reported that Mitigation Plan was submitted January 2021. LPA Brown requested Administrator Tanabe to send a copy of Mitigation Plan via email. 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 or isolation gowns. LPA Brown went over the various recommended training for facility staff with Administrator Tanabe in relation to COVID-19 and informed Administrator Tanabe staff needs to be 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 Tanabe 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 masks. LPA Brown will be issuing a deficiency for this item due to the facility just had COVID-19 positive resident last month, and N95 masks needs to be *** Continuation in LIC809C *** worn when a resident is COVID-19 positive or under observation while awaiting test results. Additionally, most residents and staff have been vaccinated and are practicing other COVID-19 precautions, which minimize the risk of them contracting COVID-19. LPA Brown will be providing Administrator Tanabe 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. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and their residents for COVID-19, 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, Administrator Tanabe handed LPA Brown copies of Emergency Care Requirements, and LPA Brown instructed Administrator Tanabe to post it in the Bulletin Board. In the process of conducting the annual inspection, LPA Brown discovered that the facility allowed one (1) caregiver, Staff 1 (S1) to work at this facility without fingerprint clearance. It appears that S1 have been allowed to work at the facility since 10/30/2021. Although Administrator Tanabe reported that S1 was sent to get fingerprint cleared, per records review, the criminal background clearance is still pending and there is no proof provided that S1 was cleared to be allowed to work at the facility. Therefore, this facility will be cited for civil penalties. Also, during the tour of the inside and outside of the facility, LPA Brown observed four (4) window screen doors in disrepair. LPA Brown will be issuing a deficiency for not having the windows screen in good repair. An exit interview was conducted with Administrator Christopher Tanabe and a copy of this report (LIC809), LIC 809D's, LIC421BG and Appeal Rights were discussed and provided.