Facility Evaluation Report

On 1/7/2022 at 10:50AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct an Infection Control Inspection. LPA met with Personal Wellness Supervisor, Annette Winn. Program Director, Angelique Goldberg arrived 15 minutes later.

Upon entry, LPA's temperature was checked and staff completed visitor's log for LPA. LPA observed hand sanitizer at screening station. LPA toured facility including but not limited to bathrooms, kitchen, common areas, and outdoor areas. LPA observed cough etiquette, signs & symptoms, and physical distancing are posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hand washing posters were posted at sinks and bathrooms.

During record review, LPA observed visitors log and temperature log for both residents and staff. LPA observed facility has a copy of Mitigation Plan on file. LPA observed staff have completed fit testing and provided documentation. LPA observed PPE and paper supplies are sufficient.

At 11:00AM, LPA observed unlocked scissors in the kitchen drawer and unlocked over the counter (OTC) medication belonging to staff. Staff locked up scissors and OTC medications during inspection.

The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights was provided.