Routine inspection·June 16, 2021

Licensing Program Analyst (LPA) K. Hiratsuka, arrived at the facility unannounced on 06/16/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Executive Director (ED) Jeffrey Gollihar, and explained the purpose of the visit. Prior to initiating the annual inspection visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Facility Representative and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by the receptionist. LPA and ED toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, four (4) resident bedrooms, common restrooms, resident laundry rooms, and the memory care unit. a. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and ED completed the infection control domain and facility was found to be in substantial compliance at this time. A couple of topics were discussed. LPA obtained the following during today's visit: -copy of liability insurance -copy of management agreement. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.