Routine inspection·November 17, 2021

On 11/17/2021, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA observed COVID-19 signs posted by the entrance. LPA was screened at the front entrance. LPA was greeted caregiver, Perfectoau (Bok) Eugenio, and the Administrator arrived shortly and assisted with the rest of the inspection. LPA explained the purpose of the visit. LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, staff training and policies, resident and staff daily monitoring records, containment strategies- all the residents have their own room. There are 2 bathrooms at the facility and if a resident tested positive for COVID-19, the bathrooms will be disinfected after each use. Hand-washing sign with 20 second instruction is posted by the sinks in the bathrooms. PPE supply and the environmental cleaning supply are adequate, bathrooms are equipped with liquid soap, and hand washing instruction is posted by the hand washing stations. Medications, toxins and sharps are stored appropriately and inaccessible to resident, a comfortable temperature is maintained, lighting is sufficient for comfort and safety and food supply was checked and observed to be sufficient. First-aid kit is inspected and completed. LPA's recommendations: be consistent with documenting the visitor's temperature on the screening log, N95 fit testing for all staff, closed lid trash can in the bathrooms and resident's rooms, and replace the cloth towels in the bathrooms with paper towels. During today's inspection, LPA Han requested for the following documents to be submitted to the Regional Office by 11/19/2021 - LIC500 (Personnel Report) - LIC308 (Designation of Administrative Responsibility) - Administrator Certification and/or renewal documents No deficiency cited today This report is discussed and reviewed with the Administrator. A copy is provided.