Post-licensing visit·May 26, 2022

Licensing Program Analyst (LPA) Victoria Willis arrived unannounced to conduct a Post Licensing inspection and met with Licensee, Eufrasia (Oliva) Garcia Arizmendi.. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival, LPA observed posters outside notifying visitors that masks must be worn in the facility and what the facility's visitation policy is. Once inside, LPA observed a screening station near the entrance that included a visitor sign in. Licensee checked LPA temperature and LPA confirmed that facility is screening visitors and verifying visitor vaccination per Provider Information Notice (PIN) 21-40-ASC. LPA initiated a walk-through of the facility around 12:40 pm 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 on each shift. Facility maintains documentation of staff and resident daily temperatures. Facility has a designated visitation area outside and is allowing for visitation in resident rooms per CCL guidance. Staff have completed PPE training but have not been N95 fit tested. LPA discussed options for getting staff fit tested with Licensee. LPA and Licensee discussed visitation and activities. Facility has at least 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. Licensee and LPA discussed their Emergency Disaster Plan and the Infection Control Plan. The Infection Control Plan is due June 30, 2022. LPA confirmed that Licensee is updating resident files for residents who lived in the home prior to the recent Change of Ownership. No deficiencies cited during this inspection.