Routine inspection·February 22, 2023

Licensing Program Analysts (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual visit at 1:20 PM. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Ivy Sudjati and discussed the reason for the visit. The LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 5 total bedrooms – two (2) bedrooms are shared rooms, two (2) bedrooms are private rooms and one (1) room is for staff. RESTROOMS: Three (3) restrooms for resident use were observed to be clean and sanitary and in operating condition. The bathrooms and showers were also observed to have grab bars and non-skid mats. The LPA observed sufficient amounts of soap and paper products in each restroom. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. The LPA observed the required postings. Fire extinguishers was last serviced 4/6/22. The smoke detectors and carbon monoxide were tested and functioned properly during the visit. The backyard had furniture appropriate for residents' use. Laundry room had locked storage area for supplies. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Medication, knives and cleaning supplies were in locked cabinets. INFECTION CONTROL : During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. The facility has a central point for symptom screening. LPA noted that the facility is allowing visitors for both indoor and outdoor visitation. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and they are able to obtain more if 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 citations were issued during today's visit. Exit interview conducted. Copy of the report provided to administrator via email.