Routine inspection·March 7, 2022

Licensing Program Analyst, Cuadra, arrived unannounced to conduct an Annual Required Inspection – 1 yr. Infection Control inspection to this facility and met with Caregiver, Rosa Ascencio. Licensee, Leah Archer was available by phone and gave permission for caregiver to sign report. LPA conducted a Risk Assessment with staff. LPA/Licensee reviewed PIN 22-05, 22-06, 22-07 & 22-09. LPA arrived at the facility and had their temperature checked and logged into a sign-in sheet. LPA observed that facility doesn't have posters on the front door indicating visitors about updated visitor's policy to protect residents in care. Once inside the facility, LPA observed that staff were wearing masks during this visit. LPA/staff conducted a walk-through of the facility and observed Covid-19 posters that included hand washing signs. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer were observed in the common area of the facility. Facility bathroom are kept stocked with hand hygiene products. Commonly touched surfaces are disinfected at least once a day. Facility is able to accommodate a single room for each resident that needs to isolate and is able to serve meals and deliver medications. Facility staff have been trained on PPE protocols, but not N-95 fit tested. Staff and residents are not being monitored daily and results not documented. Facility maintains a 30 day supply of medication. Facility has 100% vaccination rate for all staff and residents have received boosters. Residents do not typically wear a mask while in the facility, but they do wear masks when in the community. Residents receive outdoor visitation. LPA discussed with Licensee about updated guidance PIN 22-07 about indoor visitation with their families. Licensee was informed about screening, documenting for symptoms and tracking purposes of all residents, staff and visitors. Facility has submitted their Covid Mitigation Plan and approved on 7/20/21. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including masks, face shields and hand sanitizer. PPE supplies are located in an accessible place for staff. Licensee will provide copies of the following by 3/21/22: Administrative Organization (LIC309), Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), Lease agreement, Liability insurance & Emergency Disaster Plan (LIC610E). No deficiencies cited during this inspection.