Routine inspection·June 17, 2021

Licensing Program Analyst (LPA) A. Canela conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and was greeted by Administrator Mary Jane Mendoza. LPA conducted a Risk Assessment with Administrator. There were 2 staff providing care and supervision for 5 residents. LPA observed that all staff were wearing face mask. LPAs temperature was checked upon entry and logged into a binder. Hand sanitizer and disposable mask were available. LPA and Administrator conducted a tour of the facility and observed that the facility was a comfortable temperature and passageways/exits were free from obstructions. Resident rooms were furnished per regulation. Signs were posted throughout the facility to promote hand washing and social distancing. Residents temperatures are being monitored daily and results are documented in binder. Facility has a 60+ day supply of PPE. Facility has a 30-day supply of medication for residents. Facility has conducted staff training on infection control along with LPH. LPA provided the following guidance to staff: Add a field on sign-in sheet so visitors can include their contact information. Complete N-95 Fit Testing for all staff. Review PINs 21-18-ASC and 21-17.1-ASC for new guidance regarding visitation, communal dining, etc. No deficiencies were cited during today's inspection.