Routine inspection·June 11, 2021

Licensing Program Analyst (LPA) K. Hiratsuka, arrived at the facility unannounced on 06/11/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Facility Representatives Melissa Johnson and explained the purpose of the visit. Prior to initiating the annual inspection visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Facility Representative and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Melissa Johnson.. LPA is doing this visit at the same time as NEW VISION SERVICES SENIOR CARE 2 # 455002747 because they share a backyard. This facility has a fire clearance for six non-ambulatory residents. There are five resident rooms; one may be shared and four are private. The main entrance opens to the main sitting area. To the left of main entrance is a hallway leading to four resident rooms which two have exits to the outside, and two full common bathrooms. One of the bathrooms also shares a door to one of the resident rooms. Across the main entrance is the kitchen, dining, and a second sitting area. There is a resident room next to the second sitting area. There is a door leading to the garage and the laundry machines are in the garage. The backyard shares space with two other facilities licensed by the same licensee. They are NEW VISION SERVICES SENIOR CARE 2 #455002745; and NEW VISION SERVICES SENIOR CARE 1 #455002748. There are two locked sheds in the shared backyards. Several topics were discussed as well as infection control. The following needs to be updated and submitted to CCLD by the end of June 2021: LIC 500 facility personnel or staff schedule LIC 308 designation of administrative responsibility. letter stating who the current administrator is. No deficiencies cited.