Routine inspection·October 19, 2021

Licensing Program Analyst (LPA) Norman Woodridge conducted a Covid-19 Annual Inspection at the facility. Upon arrival, LPA informed Staff 1 (S1) of the purpose of the visit and was granted entry into the building. LPA and S1 conducted a tour of the inside and outside of the facility, common areas, resident rooms, restrooms, garage, and kitchen. LPA discussed and observed the following: There were 2 staff and 3 residents present at the facility. Residents rooms were clean and organized. LPA observed 2-day supply of perishables, 7-day supply of non-perishables, and stored PPE. Hallways and walkways were free from obstruction and LPA observed medication and cleaning supplies that were locked up. LPA discussed updated Covid-19 requirements with Administrator, Georgeta Firuta, and reviewed Covid-19 records for residents. LPA also reviewed Covid-19 sign in sheet for visitors. LPA discussed PIN 21-40 ASC: Updated Statewide Visitation, Waiver, and Testing and Vaccination Verification Guidance for Visitors Related to Coronavirus Disease 2019 (Covid-19). LPA provided technical assistance regarding Covid-19 related signage. No deficiencies were noted during the inspection. An exit interview was conducted and a copy of this report was provided.