Routine inspection·May 27, 2022

On May 27, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Administrator, Kesa Vodonaivalu and explained the purpose of the visit. Upon arrival LPA observed the COVID-19 signage posted at the front door. LPA Charitra was screened at entrance point and Administrator was able to provide LPA with screening log documentation for residents, staff, and visitors. LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a 6 bedroom home with half-baths in each rooms. There is one vacant room at this time. LPA observed one full bathroom. All bathrooms are equipped with liquid soap, paper towels, and a trash cans. LPA advised administrator to ensure that there are not towels in the bathrooms. Infection control practices are present: entry procedures, COVID signage, face coverings, daily monitoring for residents and staff, and 30-day PPE supply. LPA toured the living room and dining room and it was clear and free from any tripping hazards. A comfortable temperature was maintained, lighting is sufficient. LPA toured the kitchen and medications, toxins and sharps are stored appropriately and inaccessible to residents. First aid kit was observed to be completed. LPA observed 2 day perishable and 7 day non-perishable present. The following updated forms are requested to be submitted to CCLD by 6/3/22: • Administrator Certificate • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report • LIC 610E Emergency Disaster Plan • LIC 400 Resident Cash Resources Report is reviewed with administrator and a copy is provided. No citations issued during this visit.