Routine inspection·November 3, 2021

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 1:34PM. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Edna Dangiapo and discussed the reason for the visit. The LPA, along with facility Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. LPA observed a fireplace in the common living room, which is inaccessible and adequately screened. The LPA observed the required postings in the common area. Door alarms were tested and observed to be functional at the time of the visit. Fire extinguisher was fully charged and last serviced March 9, 2021. Smoke detectors were tested and functional. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. The laundry room contains locked cabinets for storage. The garage was observed locked and contained the emergency food supply, and storage. KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 5 (five) total bedrooms; 4 (four) are private resident rooms and 1 (one) is designated as a shared resident room. Report Continued on LIC 809-C RESTROOMS: The LPA observed 3 restrooms in the facility; one (1) is a shared restroom and 2 (two) are private restrooms. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening. LPA observed all staff and visitors to be wearing masks, however residents were observed not wearing face coverings in common areas. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. No deficiencies cited. Exit interview conducted. A copy of the report was provided via email.