Routine inspection·October 19, 2021

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection with the focus of the infection control domain. LPA arrived unannounced and met with the Administrator, Greg Tillman. The purpose of the visit was explained. The facility is approved for 15 residents, ages 60 and over, of which 15 may be non-ambulatory. The current census at the home is 8. This facility has a total of 10 bedrooms and 7 bathrooms downstairs. Rooms #1 - #6 are either single or shared rooms and Rooms #7 - #10 are all single bedrooms with a private bathroom. Residents do not have access to the upstairs space which is the Administrator's office. LPA toured the facility inside and out with the Administrator. The following were inspected/observed: * Signage are posted by the front entrance and throughout the facility in regards to hand washing, cough etiquette, and the Coronavirus (Covid-19). * The facility has one entry point for all visitors. Table is set up by the entrance where the visitor's log and temperature are documented. Masks and hand sanitizers are readily available. * There is a designated room to isolate individual who is tested positive for covid-19. This room has a private bathroom which is located toward the back of the house. * Extra supplies of PPE such as N95 masks, hand sanitizers, and gowns were stored in the garage. * Disinfectant and cleaning supplies are stored and locked under the kitchen sink and storage space by room #6. * Bathrooms are stocked with soap and paper towels. * Medications for 4 individuals were reviewed and are being administered as prescribed by the physician. * There are adequate food supplies of 2 day perishable and a week of non-perishable observed. There are no deficiencies observed during the visit today. An exit interview was conducted and a copy of this report along with appeal rights were provided to the Co-Administrator.