Routine inspection·October 19, 2021

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted, granted entry into the facility and explained the reason for the visit. During the visit LPA toured the facility with Administrator Betty Burgos. Facility is a 5 bedroom,( 4 resident bedrooms 1 staff bedroom) and 2 bathrooms two story home. There are 5 Residents in care. LPA observed proper covid signage at front entrance of facility. Facility has required Department postings. LPA observed copy of Administrators Certificate expiring August 18, 2022. LPA toured all Residents rooms, all rooms where within regulations. All restrooms observed contained soap, toilet paper, and towels. Restrooms had proper hand washing signs posted. Residents were observed relaxing in the Living room playing Bingo. Facility has operating smoke detectors. Facility has 2 fully charged Fire Extinguishers. Facility has supply of PPE goods. Facility has refrigerator and pantry with perishables and non- perishables food supply. Facility has required Emergency Disaster Plan located in binder readily accessible. Facility has a secured location for resident medication and files. Facility has 30 days supply of medications for Residents. LPA reviewed Residents files during visit. Residents emergency contact information and Physicians reports are current. Facility has several designated visitation areas. No deficiencies noted during todays visit. An exit interview was conducted with Administrator Betty Burgos and a copy of report was left at facility.