Routine inspection·September 29, 2021

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Norman Woodridge for the purpose of conducting an Covid-19 Annual Inspection. LPA met with Administrator (AD) Joanna Manczyk and discussed the purpose of the inspection. During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, garage, and kitchen. LPA observed the following: There were 4 residents present at the facility and residents were doing well. Resident rooms were clean and organized. LPA observed a 2-day supply of perishables and a 7-day supply of nonperishables. LPA observed hallways and walkways that were free of obstruction. LPA observed Covid-19 related training logs and certificates for staff. LPA and administrator discussed Provider Information Notice 21-38-ASC: Update Guidance for the Use of Masks, Surgical Masks, Respirators Related to Coronavirus Disease 2019 (COVID-19). LPA also discussed Covid-19 Mitigation Plan. A copy of PIN 21-38-ASC was given administrator. No deficiencies were noted during the inspection. An exit interview was conducted with AD and a copy of this report was provided.