Routine inspection·June 10, 2022

Licensing Program Analyst (LPA) Victoria Willis arrived unannounced, to conduct an Annual Required inspection and met with Administrator, Teresa Astudillo. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival, LPA signed in and Administrator took LPA's temperature and documented it. LPA confirmed with Administrator that staff are conducting vaccination verification of visitors per Provider Information Notice (PIN) 21-40-ASC. LPA conducted a walk-through of the facility at approximately 10:20am and observed the following: Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is located throughout common areas of the facility. Observed staff had masks on during this visit. Commonly touched surfaces are disinfected twice per day. Facility check resident's temperatures twice per day and staff are screened when they arrive on shift. Facility maintains documentation of staff and resident daily temperatures. Facility has removed some of their Covid-19 posters including hand washing signs in the bathrooms. LPA has asked that hand washing signs are put back up in bathrooms. Facility has a designated visitation area outside and is allowing for visitation in resident rooms per CCL guidance. Staff have completed PPE training and have been N95 fit tested. Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has a 30 day supply of Personal Protective Equipment (PPE) including but not limited to masks, gowns, and hand sanitizer. Additional PPE is stored off-site. Facility maintains a 30 day supply of medication. Fire extinguishers were last serviced May 2022. Smoke and carbon monoxide detectors throughout facility were tested and operational. Continued on LIC809C Continued from LIC809 Administrator and LPA discussed their Emergency Disaster Plan and the Infection Control Plan. Infection Control Plans are to be sent to CCL no later than June 30, 2022. Licensee/Administrator to submit updates of the following documents by 7/10/2022: LIC 308 Designated Administrator LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if there are changes) LIC 9020 Register of Facility Resident’s Copy of Liability Insurance No deficiencies cited during this inspection.