Routine inspection·September 15, 2022

Licensing Program Analyst (LPA) Victoria Willis arrived unannounced to conduct an Annual Required inspection and met with Licensee, Donald Fletcher. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival, LPA was screened by a caregiver. LPA confirmed with Licensee that all visitors are screened and staff are conducting vaccination verification per Provider Information Notice (PIN) 21-40-ASC. LPA initiated a walk-through of the facility around 2;40PM 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 at least once per day. Facility maintains documentation of staff and resident daily temperatures. Facility has a designated visitation area outside and is allowing for visitation inside per CCL guidance. Staff continue to receive PPE training and have been N95 fit tested. LPA and Licensee discussed visitation and activities. Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including but not limited to masks, gowns, and hand sanitizer. Facility maintains a 30 day supply of medication. Fire extinguishers were last serviced July 2022. Smoke and carbon monoxide detectors throughout facility were tested and operational. Continued on LIC809C Continued from LIC809 Licensee and LPA discussed their Emergency Disaster Plan and Infection Control Plan. Licensee to submit updates of the following documents by 10/15/2022: LIC 308 Designated Administrator (if applicable) LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changes) LIC 9020 Register of Facility Client’s/Resident’s Copy of Liability Insurance LPA discussed Reporting Requirements with Licensee and provided a copy of Title 22 Regulation 87211 - Reporting Requirements. No deficiencies cited during this inspection.