Routine inspection·March 4, 2022

Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA met with S-1/Facility Administrator and explained the purpose of today's visit. This home consists of (4) bedrooms, (3) bathrooms, living room, T.V. room, kitchen, dinning area, laundry room, storage room and attached garage. LPA toured grounds. The following were observed/inspected: . COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility and throughout the facility. Signs are posted to promote hand washing, cough/sneeze etiquette, and physical distancing were observed. PPE supplies observed. These items are stored and easily accessible inside the hallway closet. Hygiene supplies observed. These items are stored inside the storage room. Water supply observed. Additional water supply observed inside the garage. Hand Sanitizer observed throughout the facility grounds. Restrooms have hand soap and hand sanitizer. Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed. Per Administrator, all (4) Residents are fully vaccinated and have their booster. Per Administrator, all staff are fully vaccinated and have their booster. Medication reviewed for (4) Residents (Residents #1 through Residents #4). Residents were be socially distanced according to local public health guidelines. Staff responsible for direct care and supervision will continue to wear masks. Exit interview conducted, a copy of this report and Appeal Rights were provided to S-1/Facility Administrator.