Routine inspection·October 15, 2021

Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and met with Administrator, Donnabell Galacia (DG). The facility currently provides care for 21 residents none of which have a diagnosis of dementia and none of which are on hospice. LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with (DG); Facility was at a comfortable temperature. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last inspected on 10/15/2021 at the time of the visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. All staff have current CPR and 1st Aid training on file. Smoke and carbon monoxide detectors were tested and found to be in working order. Toxins are stored in a locked cabinet in the facility laundry and maintenance room. There was a supply of hygiene products and paper products available for use. All resident bedrooms have lighting & appropriate furnishings. Water temperature was measured at faucets accessible to residents and was measured between 114.4 and 125.0 degrees F, which is not within regulation between 105 and 120 degrees F. However, facility shares a central water heater with a second sectioned Rehabilitation Recovery Center and building kitchen. The water temperatures are adjusted depending on faucet proximity to central water heater. Maintenance Director immediately lowered water temperature. LPA reviewed Maintenance Director's water temperature log and was found to be completed daily. LPA explained regulation requirements and Maintenance Director agrees to submit a 10-day water temperature log to CCL by 10/28/2021 to ensure regulation requirement is met. Continued onto LIC9099-C Infection Control: Facility has submitted a mitigation program plan which has been reviewed. Majority of residents and all staff are vaccinated with no symptoms. Surveillance testing is being conducted at 50 percent twice per month for all staff. Posters have been placed at the front door, and facility has a station at main entrance with a sign in sheet, hand sanitizer and other items designated for visitors and staff. Staff and residents are screened for temperature and symptoms twice per day. No deficiencies cited during today's visit. Appeal rights given. LPA provided an electronic copy of the report to Administrator. Signatures on file.