Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Wallace arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection visit. LPA was met by staff who informed Administrator of the LPA' s visit. LPA explained the purpose of the visit and staff accompanied LPA on the facility inspection.

LPA and staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 15 bed facility with a current census of 15. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. The hallway has COVID-19 precautions in place including social distancing noted. Medications and toxins noted to be locked to residents in care. Resident rooms were sanitary and had the required furniture and furnishings. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2-days perishables in place. LPA also conducted the infection control domain tool. LPA observed the temperature inside the facility was measured at 74*F, which is within the required range of 68 degrees F and 85 degrees F. The hot water was measured at 110.3*F, which is within the regulatory range of 105 - 120 degrees F.

The facility submitted a LIC 808 mitigation plan , which was approved. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing stations, COVID-19 informational signage, and social distancing signs posted throughout the facility, on the front door, and outside. The facility has a designated infection control lead individual. The facility is able to designate and dedicated a COVID-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. Smoke and carbon detectors were in good repair. Fire extinguishers are current and expire on 11/30/2022.