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25 | Licensing Program Analyst Jose Villalobos conducted an unannounced visit for the purpose of conducting the required annual inspection focused on Infection Control Domain. LPA's met with Administrator, Yitzi Teichman, who assisted with today's visit.
The facility is a large 2 story building with (93) client rooms licensed to serve up to (185) clients of which all are ambulatory. The overall structure is described as 2 connected buildings known as Building A and Building B. Building A houses the main lobby, medication room, kitchen, dining room and two laundry rooms. Building B consists of a quiet room, TV room, an activity room, 2 laundry rooms and 3 offices. The (93) rooms are among the first and second floor of each building. Each client room has their own bathroom. Based on the client population being served and the census, at the time of this visit, the facility is operating within the conditions and limitations specified on the license.
On todays visit LPA Villalobos was screened upon entry into the facility. LPA toured the physical plant, reviewed sixteen (16) client and five (5) staff files, and the medication records for (16) clients. LPA observed required amount of perishable and non-perishable food items, fully stocked first aid kit, sufficient linen supplies, hygiene supplies, security cameras located in common areas, required postings related to infection control all around the hallways and common areas. LPA observed staff monitor client temperatures and log on a chart. The facility has a total of 2 elevators, one in each building and were operational. The water temperature was within required range. Fire alarms, carbon monoxide detectors and the signalling systems are interconnected and notify the fire department when triggered. Fire panel last serviced 6/16/21. Toxins and sharps locked and inaccessible to residents. Fire extinguishers fully charged. The last fire drill was conducted on 7/9/21. Administrator certificate expires on 9/30/21. Facility has an approved mitigation plan as of 4/24/21. Physical plant clean and free of debris.
No deficiencies are cited at the time of this visit. Exit interview was conducted and a copy of the report provided to administrator Yitzi Teichman |