Routine inspection·February 2, 2023

Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 02/02/2023 to conduct a required - 1 year inspection. This inspection is focused on the infection control procedures and practices of this facility. LPA met with Lead Staff, Jennifer Andersen. LPA toured building and grounds which were clean and in good repair. Exits and walkways were clear from obstructions. Facility is screening visitors and staff at the front entrance. Facility has a sufficient amount of personal protective equipment to support a resident in isolation. Facility has conducted infection control training with staff. Staff and residents are fully vaccinated and boosted. Facility had a sufficient amount of perishable and nonperishable food. Carbon monoxide and smoke detectors were observed throughout the facility. Fire extinguishers inspected were charged and current. Toxins were locked and secured. Medications are centrally stored and secured. LPA is requesting the following documents be submitted to Community Care Licensing within 30 days of today's inspection: LIC 308 Designation of Facility Responsibility LIC 610 Emergency Disaster Plan Evidence of Liability Insurance LIC 500 Personnel Report LIC 9020 Resident Roster Facility to submit documents for new administrator once new admin is hired. Exit interview conducted with Jennifer Andersen and a copy of this report emailed to the facility. No deficiencies cited during today's inspection.