Routine inspection·September 28, 2021

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Caregiver Maria Cruz and explained the reason for the visit. Administrator Maria Cecelia Domingo has an administrator certificate expiring on 07/11/2022. Administrator Maria Cecelia Domingo arrived during the visit. At 11:30 AM, LPA toured the facility with Administrator Domingo. Facility has 6 residents in care during today's visit, with 3 on hospice care. LPA observed residents relaxing in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms are single occupancy and had the required elements as well as restrooms stocked with soap/ sanitizer. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the entrance of the facility. Facility utilizes a visitor sign in sheet. Facility takes resident temperatures daily and documents. Facility has covid precaution postings as well as all required department postings. LPA observed the first aid kit has all required items. Facility mitigation plan has been approved. LPA observed an ample supply of emergency food and water. LPA toured the outside grounds and observed the shaded outside visitation area. Exit gate is unlocked and self latching. Residents participate in activities such as exercise and music. LPA observed the locked medication storage area. Facility has ample supply of PPE and cleaning supplies. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. LPA reviewed six resident files during the visit and all files are up to date including emergency information. All residents and staff are vaccinated for Covid-19. No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.