Routine inspection·July 15, 2021

Licensing Program Analyst (LPA) Jim August conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and granted entry into the facility by Administrator Sarah DeVore and explained the reason for the visit. LPA August toured the facility. There are sixty eight residents residing in the facility and no active covid-19 cases. All residents appeared clean and well taken care of. LPA observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed had ample soap/ sanitizer and appeared clean. Resident bedrooms appeared clean and sanitary and had all required components. Facility is taking residents temperatures daily and documenting results. LPA observed the emergency disaster and evacuation plans. Facility has back-up emergency food and water supply as well as PPE supplies. Facility has completed the LIC808 Mitigation Plan and LPA August approved the plan on site. The facility is still conducting Covid-19 staff testing as required by the latest guidance. No citations noted during today's visit. Exit interview conducted and a copy of this report was left at the facility.