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25 | On 01/12/24 at 1PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct infection control inspection. LPA met with administrator and explained the purpose of the visit. LPA observed 2 residents eating lunch while the other 4 clients were out attending their adult day programs. Facility fire clearance is approved for 6 ambulatory residents. Administrators certificate# 6042357740 expires 06/27/25 and #6059648735 expires 09/07/2025.
LPA toured the facility including but not limited to the front entrance, screening station, hand washing stations, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizer were observed at the screening station. Cough/sneeze etiquette, social distancing signs were posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs maintained at a central location and easily accessible for staff. Fire extinguisher is observed fully charged and was last inspected on 10/16/23. Comfortable temperature is maintained at 70 deg F. Facility has a mitigation plan in place and maintains records of routine screening for residents and staff. The infection control leader is the administrator. During visit, LPA reviewed 3 staff files and 5 resident files. LPA also interviewed 2 staff and 2 residents.
Updated copies of the following documents were obtained during visit:
· LIC500- Personnel Report
· LIC308- Designation of Facility Responsibility
· LIC610E- Emergency/Disaster Plan including infection control plans
· Evidence of Liability Insurance
No deficiencies cited during visit. Exit interview conducted and a copy of this report provided. |