Routine inspection·July 11, 2022

On June 11, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual infection control inspection. LPA met with Caregiver, Evelyn Tabago, and Administrator, Jennifer Tobias joined shortly thereafter. LPA explained the purpose of the visit. Upon arrival, LPA observed the COVID-19 posting on the front door, however advised Caregiver to post more COVID reminder signage. LPA was screened at entry point and caregiver was able to provide LPA with screening log documentation for staff, residents, and visitors. LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a single story facility with 7 bedrooms; all private rooms and 5 bathrooms; 2 full and 3 half baths. Infection control practices are present: entry procedures, face coverings, daily monitoring for residents and staff, COVID-19 signage posted throughout the facility, and 30-day PPE supply. LPA observed bathrooms to be equipped with hand-washing signs, liquid soap, and paper towels. LPA advised caregiver to ensure communal bathrooms have a trash can with a fitted lid and the remove hand/bath towels from the bathrooms. LPA observed medications and toxins locked and inaccessible to residents. LPA toured the kitchen and observed 2 day perishable and 7 day non-perishable present. LPA observed sharps drawer to be unlocked and accessible to residents, however according to the administrator, the kitchen door is locked at all times unless staff is in the kitchen. A comfortable temperature is maintained and lighting is sufficient for comfort. Extra linen was observed to be present. Washer and dryer was observed to be in good working condition. (CONT. TO 809C) LPA requested for the following to be submitted to CCLD by 7/18/2022: LIC309 Administrative Organization LIC308 Administrative Responsibility LIC500 Personnel Report LIC610E Emergency Disaster Plan Administrator Certificate This report is reviewed and discussed with Administrator, Jennifer Tobias; a copy is provided.