Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. The purpose of the visit was explained to Administrator David Kim.

There are 10 residents ages 60 and above [ 6 ambulatory, 3 non-ambulatory, & 1 bedridden]. A Dementia waiver and an approved hospice waiver for 6 residents is in place. The last fire emergency drill was conducted on 2/6/2023. The last fire Inspection was completed on 8/29/2022 by Eminent Fire Protection. Administrator certificate expires 3/9/2024.

COVID-19 Infection Control Practices and signs were observed in the main entrance and restrooms. A visitor sign in station was observed outside the main entrance. Per Administrator, visitors are no longer being screened due to public health order changes in 2022. Visitors are screened by staff only if needed.

Staff wear masks. Residents do not wear masks due to health and cognitive issues.

Sufficient supply of Personal Protective Equipment (PPE's) was observed. The facility has a contingency plan for back-up staffing if needed.

The facility sub mitted a COVID-19 Mitigation Plan. An Infection Control Plan (ICP) has not been submitted. Submit the ICP as soon as possible. The plan should be reviewed and updated as necessary. Administrator has agreed to submit their Infection Control Plan by [up to 60 days from inspection].

30-day centrally stored resident medications were observed.