Routine inspection·October 11, 2021

On 10/11/2021, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and requested to meet with the Administrator. LPA was met by Caregiver Nancy Wade. Jill Stowell, Administrator was called by caregiver. Administrator states unable to meet with LPA due to quarantine. Administrator authorized caregiver Nancy Wade to conduct visit and sign report with LPA. All five residents were present during the inspection. LPA conducted tour with caregiver. Facility staffs was observed with mask on. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. All bathrooms are observed with trash cans with lid and securely fastened grab bars. Bathrooms have non-skid mat. LPA observed hand washing posting by all sinks. Social distancing and cough etiquette postings observed in facility. All resident’s room toured and observed to be adequately furnished and lit. LPA observed 1 shared resident’s bedroom to be at least 6 feet apart and 3 bedrooms that are single occupant. LPA checked residents’ locked medications and observed a 30-day PPE supplies. Food supply was checked and appeared to be an adequate supply. Cleaning supplies were stored and locked under kitchen sink and in garage cabinet. The exterior tour was conducted. Side gate was self-closing and self-latching. LPA observed fire extinguisher served date: 04/16/21. Staff records were reviewed for good health and infection control training. All residents’ records reviewed to have updated emergency contact information. No deficiencies issued during this inspection. Exit Interview conducted. Administrator and caregiver was informed that as COVID-19 precautionary measure, this report will be provided via email and an electronic read receipt confirms receiving this document. Report signed on-site.