Routine inspection·July 29, 2021

Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced Required One (1) year-Infection Control inspection to the facility. LPA met with Adam Braun, Director of Operations and explained the reason for the visit. A tour of the physical plant was conducted at 10:10am and the following was noted: There is only one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign in sheet and hand sanitizer is available. LPA was screened upon entry. The facility had submitted and approved Mitigation Plan. Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the door. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has sufficient stock of PPE in the storage room. The facility has fifteen (15) bedrooms and nine (9) bathrooms currently occupying twenty-three (23) residents. (continued on LIC 809-C) Living and dining room furniture were checked. The living room is neat and clean. The facility maintains a comfortable temperature at 76 degrees. The smoke detectors are hardwired and interconnected and observed to be operational. There is a carbon monoxide detector in the facility. Fire extinguishers are located throughout the facility. There is no body of water at the facility. Passageways were observed to be clear from obstruction. Laundry area is located in the lower level. Laundry detergents, cleaning agents and other toxins are stored in a cabinet which was observed to be locked. Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents. The residents rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passage ways are lit. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the showers and toilets. The hot water temperature was measured at 111.2 degrees F. There was enough clean linen available in the closets. Medications-LPA observed medication cart to be locked and inaccessible to residents. There were two ( 2) complete first aid kits located in an office adjacent to the kitchen. No deficiencies are cited at this time. Exit interview conducted. A copy of this report was issued and signature obtained.