Routine inspection·May 5, 2022

On this day Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and was granted entry into the facility by Staff. LPA explained the reason for the visit. At 1:15 PM LPA toured the facility with Staff. Facility is a 7 bedroom (6 resident rooms and 1 staff room) and 4 bathroom single story home. There are 6 Residents in care. LPA observed proper Covid signage at front entrance of facility. LPA observed facility has required Department postings visible to the public and residents. LPA observed copy of Administrators certificate expiring 01/27/23. Facility has required mitigation plan and Emergency Disaster Plan posted. Upon entry of facility a guest sign in station with hand sanitizer was accessible. LPA toured all resident rooms, rooms appeared clean, sanitary and where within regulations. All restrooms observed contained a working water basin, soap, hand sanitizer, wipes gloves, toilet paper and paper towels. Restrooms had proper hand washing signs posted. Residents were observed relaxing in bedrooms and sitting in common area living room. Facility has operating smoke detectors and carbon monoxide detectors. Facility has PPE supply. Facility has 2 refrigerators and pantry with ample food supply. Facility has two day supply of perishable and seven day supply of non- perishable foods available as required by regulations. LPA observed facility has ample emergency food and water supply. Facility has 1 fire extinguisher which is fully charged. Facility has evacuation plan posted. Facility has a secured location for Resident medication and files. Facility has 30 days supply of medications for Residents. LPA reviewed 6 of 6 Residents files during visit. Residents emergency contact information and physicians reports are current. Facility has two designated outside visitation areas with ample shade. No deficiencies noted during today’s visit. An exit interview was conducted with Licensee and copy of this report was left at facility.