Routine inspection·September 6, 2022

Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and was greeted by Licensee, Helen Robago. The facility currently provides care for three (3) residents, some of which with a diagnosis of dementia. LPA arrived at the facility and had temperature and symptoms checked. LPA continued with a tour of the facility with Licensee; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 5/2/2022 at the time of the visit. Smoke and Carbon Monoxide detectors were inspected and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins and cleaning supplies are found to be stored in a secured cabinet located in the garage. In addition, sharps/knives and resident medications are stored in a designated secured cabinet in the kitchen. There was an ample supply of hygiene products and paper products available for resident use. All resident’s bedrooms have lighting & appropriate furnishings. Hot water measured between 108.5 and 108.8 degrees F which is within Title 22 regulations of 105 to 120 degrees F in faucets used by residents. Auditory alarms were located at each exit, tested and found to be in working order. LPA conducted a review of staff training records and found staff to have current CPR & 1st Aid Certification. Continued onto LIC809-C Infection Control: Facility to submit Infection Control Plan which will be reviewed. All staff and residents have been vaccinated with no reported or observed symptoms. Posters have been placed at the front door, hallways and restrooms promoting COVID mitigation and protocols. There is a station at main entrance with a sign in, hand sanitizer and other items designated for visitors and staff. Staff are screened for temperature and symptoms on a daily basis and residents are screened observation and change of condition. Licensee, Helen Robago's Administrator's Certificate 6021326740 expires on 10/28/2022. Licence will be submitting completed hours of training to CCLD for updated Administrator's Certification. No deficiencies cited during today's visit. LPA requested the following documents be sent to CCL by COB 9/20/2022: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate(s) Copy of Liability Insurance