Routine inspection·May 25, 2021

Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility 11am to conduct an unannounced infection control inspection/visit. Upon arriving, LPA contacted the facility, and spoke to Co-Administrator Bozena Kozbial, who gave LPA current information pertaining to the residents and facility. The Co-Administrator reported to LPA, that there have not been any active or past COVID cases at the facility, and staff and residents have been vaccinated. The current census is (5). LPA was greeted at the front door by the Co-Administrator Bozena, who allowed LPA to enter; LPA’s temperature was immediately taken and documented; a list of COVID-19 questions was asked; and LPA signed in the visitor book. LPA observed all staff to have full mask covering; a hand sanitizing station; PPE supplies in drawer; and COVID-19, CDC, Department of Public Health, and Licensing postings on the walls throughout the facility. The Administrator Elizabeth Godlewska arrived shortly after, with food supplies for the facility. The infection control inspection began with the Co-Administrator escorting LPA throughout the facility. The facility has (3) bedrooms; with (1) shared room and beds were kept (6) feet apart. All bedrooms were properly furnished; with each resident’s door posted with COVID-19 procedures and protocols. The common areas were observed to be clean, including bathrooms, with soap and towels. LPA conducted a mitigation plan review with the Co-Administrator, to obtain information on how the facility has implemented the plan. The Co-Administrator reported to LPA, the facility has hired an outside agency to continue with the COVID-19 surveillance testing, which is done every (2) weeks for staff and residents. The facility keeps documentation of the test results and other pertinent information pertaining to COVID-19. All new employee hires and new resident admits, must be properly screened and provided a negative COVID test, prior to entering the facility. Administration has conducted training to staff in relation to COVID-19 and has documentation, as well as staff have been notified that there is a paid sick leave policy in place. There are designated rooms for potential positive COVID residents. PPE, chemicals, cleaning supplies, emergency food and water, personal hygiene supplies, and paper products are stored in the garage area, which was locked and secured. LPA observed a (30) day supply of all items during the visit. LPA observed the facility has Licensing requirement for food supply. Currently, the facility has sufficient staff, and has a hiring plan in place if needed. The facility has not had any positive COVID-19 reports for staff or residents. The Co-Administrator informed LPA that they continue to implement the best practices for their facility; which has kept them COVID-19 free. The facility is aware to report any changes with residents and staff to Licensing and there LPA, pertaining to positive COVID-19 cases. Exit interview was conducted with Administrator and Co-Administrator. In order to continue implementing safe measures surrounding the situation of the Coronavirus Disease 2019 (COVID-19), today’s Licensing report (LIC809) would not be issued during the visit; but submitted via email by the end of the day, and signature will be provided by both LPA and Administrators.