1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25 | On 11/15/2022 at 03:10 PM, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced Infection Control Inspection. LPA explained the purpose for the visit to Care Staff and Agnes Fernandez, Administrator(ADM).
Facility has a COVID-19 mitigation plan on file. LPA requested a staff and resident roster. LPA observed a screening station at the entry that contained thermometer, masks, hand sanitizer, COVID-19 signage, and a visitor sign-in log. LPA toured the facility including, but not limited to common areas, bathrooms, bedrooms, kitchen, and backyard. LPA observed masks, cough etiquette, social distancing and hand washing signs posted throughout. ADM to post 20 seconds to hand washing signs in bedrooms and kitchen. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap, paper towels and covered garbage cans. There is a surplus of PPE centrally stored inside the facility's hall closet that is accessible to all care staff. Hot water temperature in the shared residents' bathroom was measured at 117.4 degree Fahrenheit (F) and the facility's temperature was at a 70 degree (F). Smoke/Carbon Monoxide detectors were observed operational and first aid kit complete.
The following forms are to be updated and submitted to CCLD:
-LIC500 Personnel Report
-LIC308 Designation of Administrative Responsibility
-LIC610E Emergency Disaster Plan (Reviewed)
-An updated copy of Administrator Certificate(s) (Reviewed)
-Infection Control Plan
Exit interview conducted and a copy of this report provided to Agnes Fernandez, Administrator |