Facility Evaluation Report

On 12/21/2021 at approximately 9:40 AM License Program Analyst (LPA) Hansen arrived unannounced to conduct a Required 1 yr. Infection Control inspection to this facility. LPA was welcomed by Administrator – Cheryl Gambonini. There are 4 residents at the facility with a hospice waiver for 2 although no residents are on hospice at this time.

At approximately 10:05 AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within Title 22 regulation of 2 days of perishable and 7 days of nonperishable. Facility kitchen was clean, and the refrigerator and freezer were clean, and food was stored properly. Toxins are stored in a locked closet in the hallway. Water temperature in 2 residents bathrooms measured 114.2 degrees F. & 116.7 degrees F within regulation between 105 degrees F. and 120 degrees F. Fire extinguishers inspected were last charged on 8/17/2021. Smoke detectors were tested and found to be in working order. Facility has fire sprinklers throughout. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure in a locked cart in the dinning room. Alarms are on all doors leading to outside.

Facility has submitted a mitigation program plan that has been approved, on 9/10/2021. Posters have been placed at facility. Facility has PPE supply stored in locked hallway closet and are placed about the facility for use. Facility has a 30-day supply of medication for residents. Staff had all PPE training required on file. LPA informed Administrator to contact local public health to get staff N95 Fit Tested. LPA discussed with Administrator Cheryl Gambonini of current requirements that all visitors must either have tracking information of vaccine or negative COVID test results from the last 72 hrs prior to visiting.