Post-licensing visit·July 21, 2022

Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct a Post-Licensing Inspection and met with Administrator Donald Stamets. LPA was greeted by staff and asked to screen for COVID. Proof of vaccination was requested. Facility is 2 stories and contains both assisted living and memory care with a current census of 111. LPA toured building and grounds which were clean and in good repair. Staff were observed wearing masks. All staff are vaccinated except 1 medical exemption and boosted if eligible. 98% of residents are vaccinated and boosted if eligible with a clinic scheduled to get all residents vaccinated by 7/31/2022. Facility currently conducts surveillance testing every Friday. LPA and administrator discussed infection control plan which has been submitted. Medications are centrally stored and locked making them inaccessible to residents. Toxins are secured and inaccessible to residents. Fire extinguishers were last inspected in January of 2022. LPA observed fire alarm/sprinkler system throughout the facility. Facility has the necessary personal protective equipment (PPE) to support a resident in isolation. All bedrooms are private therefore residents could isolate in their own bedrooms if necessary. Resident bathrooms contain necessary grab bars and non-slip floors/mats. LPA and administrator discussed Guardian and association process. No deficiencies observed during today's inspection. Exit interview conducted with Administrator.