Routine inspection·December 15, 2022

Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Annual Inspection - Infection Control. LPA met with and explained the purpose of the visit with Administrator (AD) Percival Tobias. LPA toured the facility inside and out. Upon entry, LPA observed visitor sign in and temperature check, available masks and sanitizer. Furniture in common and dining areas are spaced to promote distancing. Facility has designated visitation areas available. LPA observed soap, paper towels and hand washing signs in bathrooms. LPA observed required food supply, paper products, available PPE and resident medications. Cleaning/disinfecting products and sharps/knives were locked. LPA reviewed resident emergency contact information. Fire and Carbon Monoxide alarms were observed in working order. LPA observed fire extinguisher which was purchased 5/2/22. AD certificate expires 10/17/23. AD has agreed to revise the symptom screening forms for residents, visitors and staff. No deficiencies were cited during this inspection. An exit interview was conducted. A copy of this report was left with Percival Tobias whose signature confirms receipt of these documents. LPA requested the following updated forms by 12/22/22: LIC 308, LIC 500, LIC 610E, LIC 9020,a copy of current Liability Coverage and revised screening forms.