Follow-up·April 29, 2022

Licensing Program Analyst (LPA) Steve Chang, Licensing Program Manager (LPM) Sarah Yip, and Program Clinical Consultant (PCC) Lori Kopplinger conducted Technical Assistant - PCC through tele-inspection (Zoom) and met with Administrator (ADM) Dodie Arines. The purpose of this Technical Assistance (TA) Tele visit was to review the facility COVID-19 infection mitigation plan and conducted inspection of the facility to ensure plan is being carried out and to provide support and guidance to staff in mitigating the spread of virus. During tele-visit inspection, a tour of the facility was conducted including the main entrance, living room, bedrooms, restrooms, dining room, kitchen, laundry room. Cloth towels were observed in restroom and kitchen. No N95 masks was worn by staff. No COVID signage was posted at the main entrance door. Positive resident was observed not isolating in room. PCC nurse discussed the situation and measures with ADM. ADM stated all the staff and residents are fully vaccinated and boosted. Based on today's inspection, below are the recommendations: 1. Facility to remove the cloth towels in restrooms and kitchen. 2. Facility to add the trash cans with foot pedal covers in facility. 3. Administrator to review PINs on isolation and quarantine. 4. Facility to have N95 fitting test for staff who are caring for positive residents. 5. Facility to have hand washing signage that indicate wash for 20 seconds in bathrooms. 6. Facility to conduct staff training at least quarterly or as frequently as needed on donning and doffing of PPE, COVID -19 updates by CDC, and/or local public health and to review DSS-CCLD Providers Information Notice (PIN). 7. Facility to update the mitigation plan especially on isolation/quarantine protocol and submit the revised mitigation plan to CCL. 8. Facility to disinfect the high touched areas based on manufacture’s instruction on disinfection. 9. Facility is not to reuse PPEs, but staff need to doff used PPEs after each resident and don new PPE prior to going back to the common area. 10. Facility needs to report timely to LHD via Spot Intake Form. 11. Facility to post signage at the main entrance door. 12. Facility should use the highest temperature for positive residents’ laundry. 13. Facility should not commingle positive individuals with negative individuals in common areas. 14. Staff should be wearing N95 during this outbreak. No deficiencies cited during today's Tele Visit. Exit interview conducted with ADM. A copy of this report emailed to ADM for signature.