Facility Evaluation Report

On October 29, 2021, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual infection control inspection. Upon arrival, LPA observed signage on the front door. LPA was greeted by the Administrator, Dee Lete and explained the purpose of the visit. LPA was screened at the entry point and the administrator was able to provide screening log documentation for residents, visitors, and staff.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. Infection control practices are present: entry procedures, face coverings, daily monitoring for residents and staff, and 30-day PPE supply. Bathrooms are equipped liquid soap and paper towels and trash cans are covered with lids. During the facility tour, LPA observed 4 residents sitting in the living room and maintaining social distancing and wearing face coverings.

Signs are present regarding masking and distancing but LPA discussed the need to add more reminder signs for residents regarding cough etiquette and COVID symptoms. LPA Charitra will send administrator additional signs to add to facility.

All three rooms are occupied at this time and are semi-private rooms. The beds in the rooms are either 6 feet apart or 3 feet apart from head-to-toe. LPA observed the staff room downstairs and recommends putting hand-washing signage in the bathroom. LPA observed 2 day perishable and 7 day non-perishable present.

Medications, toxins and sharps are stored appropriately and inaccessible to residents, and a comfortable temperature is maintained, lighting is sufficient for comfort. First aid kit was observed to be completed.

The following updated forms are requested to be submitted to CCLD by 11/5/2021 :

• LIC 308 Designation of Administrative Responsibility

• Updated lease agreement or control of property information

Report is reviewed with administrator and a copy is provided. No citations issued.