Routine inspection·June 9, 2022

Licensing Program Analyst (LPA) Victoria Willis arrived unannounced to conduct an Annual Required inspection and met with Licensee, Luningning "Bot" Alicdan. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival, LPA observed posters outside notifying visitors of the mask and vaccination verification policy per Provider Information Notice (PIN) 21-40-ASC. Once inside, LPA observed a screening station near the entrance. LPA initiated a walk-through of the facility at around 1:00pm and observed the following: Facility has COVID-19 posters throughout that included hand washing signs in bathrooms. 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 three times per day and after use. Facility recently discontinued documenting staff and resident daily temperatures. LPA directed them to continue documenting temperatures and symptoms. Facility has a designated visitation area outside and is allowing for visitation in resident rooms per CCL guidance. Licensee continues to train on infection control and PPE but have not been N95 fit tested. LPA gave Licensee information to have her staff fit tested. LPA and Licensee discussed visitation and activities. Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has some PPE but LPA directed Licensee to obtain additional PPE. Facility maintains a 30 day supply of medication. Facility had a fire inspection April 2022 by the local fire department and they tested sprinklers and fire detectors. Fire Extinguishers are charged but have not been serviced in the last year. Licensee needed clarification regarding the tag on the fire extinguisher that shows when servicing is due. LPA also checked the Carbon Monoxide detector and it was functional. Continued on LIC809C Licensee and LPA discussed their Emergency Disaster Plan and the Infection Control Plan. Infection Control Plan is due 6/30/2022. Licensee/Administrator to submit updates of the following documents by 07/09/2022: LIC 308 Designated Administrator LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if there are changes) Copy of proof of property ownership once escrow closes Liability Insurance No deficiencies cited during this inspection.