Routine inspection·August 5, 2022

On August 5, 2022, Licensing Program Analysts (LPA) Komal Charitra and Kevin Varilla conducted an unannounced annual infection control inspection. Upon arrival LPA observed the COVID-19 signage posted on the front entrance. LPAs met with House Manager, Israel Wei and Licensee/Administrator, Fatollah Ghlichloo joined shortly thereafter. LPAs explained the purpose of the visit. LPAs were screened at entry point and House Manager was able to provide screening log documentation for staff, residents, and visitors. LPAs toured the facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a single story home with 4 bedrooms and 2 full bathrooms. All bedrooms were observed to be private resident rooms. During the visit, LPAs observed both bathrooms to be observed with liquid soap, paper towels, hand washing signs, non-skid mats, and a trash can with a lid. During the visit, all staff were observed with a face mask. LPAs toured the living room and dining room and it was clear and odor-free. The living room was clear from any tripping hazards. COVID-19 signs were observed to be posted throughout the facility. A comfortable temperature is maintained and lighting is sufficient for comfort. Living room and outdoor space is spacious for daily resident activities. LPAs observed the locked medication cabinet in the office room. LPAs toured the kitchen and observed 2 day perishable and 7 day non-perishable. Sharps and toxins were stored appropriately and inaccessible to residents. Freezer temperature was measured at -20 degrees F and refrigerator was measured at 40 degrees F in both the kitchen and garage. Washer and dryer was observed to be in good working condition. First aid kit was observed to be completed. 30-day PPE supply was present. Infection control practices are reviewed: entry procedures, staff training and policies, resident and staff daily monitoring records, containment strategies, PPE bin set up outside resident rooms, and face coverings. LPA requests the following forms to be sent to CCLD by 8/12/22: LIC309 Administrative Organization LIC308 Designation of Administrative Responsibility LIC500 Personnel Report LIC400 Resident Cash Resources LIC610E Emergency Disaster Plan No citations issued during this visit. Report is reviewed with Administrator/Licensee and House Manager and a copy is provided.