Blossom Garden Senior Home

Licensing Program Analyst (LPA) Delmundo conducted an unannounced infection controls annual inspection. LPA met with Avelina Sagnep, co-administrator, and informed the purpose of visit. Avelina Sagnep called Fekerte Hyesus, administrator, who arrived after about 20 minutes. Facility has an approved LIC808 COVID-19 Mitigation Plan. LPA inspected the facility inside and out with Avelina Sagnep. LPA observed screening station located near the front entrance with visitor's log, hand sanitizer and no touch temperature probe. Routine symptom screening (+/-) temperature and symptom checks are done at entry for all staff and visitors. Trash bins were observed with pedal operated lids. Medications are centrally stored in the a locked cabinet. Centrally stored PPEs inspected. There were at least 7 days of nonperishable and 2 days of perishable food supplies. Fire extinguisher was observed fully charge and tag showed serviced November 8, 2021. Smoke and carbon monoxide detectors were operational. First aid kit inspected and observed complete with manual. LPA observed the following:, 1. Visitor's poster at the entrance door outdated. 2. No COVID-19 signages inside the facility except in the common bathroom and kitchen. 3. Disposable gowns and N95 respirators not sufficient for 30 days for 5 staff. ......continued on 809C 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 26 27 28 29 30 31 32 LPA verified and Avelina Sagnep stated the following: 1. Staff are not fit tested for N95 respirator. 2. Residents' temperature are no longer routinely checked. LPA requested for copies of the following updated documents to be submitted by December 23, 2021: 1. LIC500 Personnel Report 2. LIC308 Designation of Facility Responsibility 3. LIC610E Emergency Disaster Plan 4. Proof of $3M liability insurance coverage No citation issued during today's inspection. Exit interview conducted and copy of this report provided to Fekerte Hyesus.

On 12/10/2024 at 10:25 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator and Licensee, Fekerte Hyesus and explained the purpose of the visit. At 11:05 AM, LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. The temperature inside the facility is maintained at 68 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 109.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 03/22/2024. Emergency Disaster Plan was posted visibly on the wall.First aid kit was observed to be complete. Emergency disaster drill was last conducted on 09/16/2024. At 12:25 PM, LPA reviewed 5 residents records and 5 staff records; all were complete. At 1:10 PM, LPA also reviewed a sample of resident’s medications. The following documents were requested and observed during the inspection: LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan, Copy of the Liability Insurance, and Current Administrator’s Certificate. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

Licensing Program Analyst (LPA) Delmundo conducted an unannounced infection control annual inspection. LPA met with Fekerte Hyesus, administrator, and informed the purpose of visit. Facility has LIC808 Mitigation Plan on file. LPA toured the facility inside out with the administrator. LPA inspected the living room, dining area, kitchen, bedrooms, bathrooms, side and backyard. There's adequate food supplies of perishables good for 2 days and non-perishables good for 7 days. LPA observed screening station located near the entrance with visitor's log, hand sanitizer and thermometer. Surgical masks and disposable gloves are readily available at the screening station. Temperature and symptoms check are done at entry for visitors. Antigen test kits are readily available. Residents and staff are screened for COVID-19 symptoms and temperature is checked and recorded. COVID-19 signages were observed posted all throughout the facility. Supplies of PPEs inspected. Staff were fit tested for N95 respirators. Hot water temperature in the common bathroom was tested and measured at 105.2 degrees Fahrenheit. Fire extinguishers checked, observed fully charge with tags showed serviced November 8, 2021. Administrator provided to LPA on this day copies of the following: 1. New Infection Control Plan 2. $3M liability insurance certificate ......continued on 809C 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 26 27 28 29 30 31 32 Administrator to submit the following by November 25. 2022: 1. Monkeypox Infection Control Plan 2. LIC308 Designation of Facility Responsibility 3. LIC500 Personnel Report 4. LIC610E Emergency Disaster Plan (9 pages) No deficiency observed. Exit interview conducted and copy of this report provided.