Facility Evaluation Report

On 12/13/2022 at approximately 9 AM License Program Analyst (LPA) Hansen arrived unannounced to conduct a Required 1 yr. Infection Control inspection to this facility. LPA was welcomed by Licensee – Cheryl Gambonini. There are 4 residents at facility, currently none on hospice or with dementia.

At approximately 9:15 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 and are in highly visible area. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked closet in the hallway. Water temperature in 2 residents bathrooms measured 111.7 degrees F. & 113.3 degrees F within regulation between 105 degrees F. and 120 degrees F. Fire extinguishers inspected were last charged on 8/17/2021 and has been given a technical assistance for being out of compliance date, although charged (see LIC 9102). Smoke detectors were tested and found to be in working order, but facility did not have carbine monoxide detectors, TA was given to be replaced by end of week (see LIC 9102) Facility has fire sprinklers throughout. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure in locked cart in dining room. Alarms are on all doors leading to outside.

Facility has submitted a mitigation program plan and Infection Control Plan. 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.