The Villas at Cloverdale

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced to conduct an Annual Required inspection and met with Licensee/Administrator, Kristi Shehan. LPA initiated a tour of the facility around 12:45pm and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in bathrooms used by residents measured at 107 and 109 degrees F which are within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cabinets containing cleaning supplies were locked. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. Emergency food and water supplies are stored in the garage. Personal Protective Equipment is also stored in the garage. Fire extinguishers were last serviced October 2023. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational during inspection. Most recent fire drill was conducted October 2023. Three staff files and five resident files were reviewed. Staff have required First Aid and CPR certificates. Administrator Certificate for Administrator, Kristi Shehan is expired but is on the Department's pending list. Medications and medication records were reviewed. Training records were also reviewed. Continued on LIC809C Continued from LIC809 Licensee/Administrator to submit updates of the following documents by 12/07/2023: LIC 308 Designated Administrator (If applicable) LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (review and update if changes) Infection Control Plan (if changes) No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Nov 7, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced to conduct an Annual Required inspection and met with Licensee/Administrator, Kristi Shehan. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival LPA observed the screening area. Facility continues to screen visitors per CCL guidance. LPA initiated a walk-through of the facility around 11:45 am and observed the following: Facility has COVID-19 posters throughout that include hand washing signs in bathrooms. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is located throughout common areas of the facility. Observed staff had masks on during this visit. Commonly touched surfaces are disinfected three times per day, once on each shift. Facility maintains documentation of staff and resident daily temperatures. Facility has a designated visitation area outside and is allowing for visitation in resident rooms per CCL guidance. Staff continue to receive training on infection control and donning and doffing of Personal Protective Equipment (PPE) and have been N95 fit tested. LPA and Licensee discussed visitation and activities. Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has more than a 30 day supply of PPE including but not limited to masks, gowns, and hand sanitizer. Facility maintains a 30 day supply of medication. Fire extinguisher was fully charged and last serviced June 2021. Facility's fire extinguisher vendor recently changed ownership so annual servicing was delayed. Licensee made contact with company during inspection and scheduled a service date. Carbon Monoxide and smoke detectors were tested and operational. Continued on LIC809C Continued from LIC809C Licensee and LPA discussed their Emergency Disaster Plan and Infection Control Plan. Licensee/Administrator to submit updates of the following documents by 11/11/2022: LIC 308 Designated Administrator (If applicable) LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (review and update if changes) No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Oct 11, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Willis arrived unannounced to conduct an Annual Required inspection and met with Licensee/Administrator, Kristi Shehan. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival, LPA observed a notice on the front door which outlined the facility's visitation and Covid-19 screening policy. Upon entry into the facility LPA's temperature was taken by the Licensee and LPA was asked to fill out a questionnaire with standard Covid-19 screening questions. LPA initiated a walk-through of the facility around 9:35pm and observed the following: Facility has COVID-19 posters throughout that includes hand washing and cough etiquette signs in bathroom. Hand sanitizer is located throughout common areas of the facility. Other hand-washing supplies were also observed in bathroom. LPA confirmed with Licensee that they are conducting vaccine verification for visitors per Provider Information Notice (PIN) 21-40-ASC. Facility was a comfortable temperature and exits were free from obstructions. Observed staff had masks on during this visit. Commonly touched surfaces are disinfected three times per day, on each shift. Facility maintains documentation of staff and resident daily temperatures. Facility has a designated visitation area outside. Visitation is allowed inside the facility after vaccination verification or proof of a negative test within 72 hours, per current CCL guidance. Staff have completed PPE training and have been N95 fit tested. Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including but not limited to masks, gowns and hand sanitizer. Facility maintains a 30 day supply of medication. Licensee and LPA discussed their Emergency Disaster Plan. Fire extinguishers have been serviced within the last year. Facility recently had an inspection by the local fire department. No issues noted. LPA requested the updated lease from Licensee. No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Nov 19, 2021