Routine inspection·January 5, 2022

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility and explained the reason for the visit. LPA Tirre toured facility with Licensee Jennifer Perez. Facility is a two story, 8 bedroom (3 resident rooms, and 5 staff bedrooms) with 2 bathroom home. There are 5 Residents in care. LPA observed proper covid signage in entry way of facility. Facility has required Department postings. LPA observed copy of Administrators Certificate expiring 5/15/2022. LPA toured all Residents rooms, all rooms where within regulations. All restrooms observed contained soap, wipes, toilet paper and paper towels. LPA observed several visitation areas with ample seating. Residents were observed relaxing in the Living room watching TV. Facility has audible alarm system and smoke detectors. Facility has 1 fire extinguisher fully charged. Facility has ample emergency food and water supply. Facility has required Emergency Disaster Plan posted inside facility. Facility has a secured location for resident medication and files. LPA observed residents medications and facility has 30 days supply of medications for Residents. Residents emergency contact information and Physicians reports are current. Facility has ample supply of PPE supplies. No deficiencies noted during todays visit. An exit interview was conducted with Licensee Jennifer Perez and a copy of this report was left at facility.