Routine inspection·October 21, 2021

On 10/21/2021, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA observed COVID-19 signs posted by the entrance. LPA was greeted by the Caregiver in charge, Rosema Caspillan. LPA explained the purpose of the visit and LPA was screened at the front entrance. 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 residents have their own private room and the facility has designated a bathroom for the resident with COVID-19 symptoms if needed), there are 5 bedrooms in the facility and 4 of them are private rooms and 1 is shared but currently there is only 1 resident occupying that room; PPE supply and the environmental cleaning supply are adequate (LPA informed the facility that the Regional Office has PPE supplies to share if needed); bathrooms are equipped with soap and paper towels, and hand washing instruction is posted by the hand washing stations. Signs are posted through-out the facility. The trash can in the kitchen has a closed lid and LPA suggested to replace the rest of the trash cans with lids as well. 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 kits are inspected and complete. There are 4 residents (1 went to On-Lok Adult Day Program), and 2 staff members present during the inspection. During today's inspection, LPA Han requested for the following documents to be submitted by 1028/2021 and recommended to have additional COVID-19 signs. - Updated Administrator Certification, LIC308, Facility Lease and Updated Emergency Disaster Plan LIC610E No deficiency cited today. This report is reviewed and discussed with the Caregiver and a copy is provided.