Routine inspection·July 20, 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 by Staff and explained the reason for the visit. During the visit LPA toured the facility with Administrator Amy DeBoom. Facility is a 6 bedroom,( 5 resident bedrooms 1 staff bedroom) and 4 bathroom single story home. There are 6 Residents in care. LPA observed proper covid signage at front entrance of facility as well as sign in, sanitization and temperature check station. Facility has required Department postings. LPA observed copy of Administrators Certificate expiring June 28, 2022. LPA toured all Residents rooms, all rooms where within regulations. All restrooms observed contained soap, toilet paper, paper towels, disinfection wipes and hand sanitizer. Residents were observed relaxing in the Living room and eating lunch in kitchen. Facility has working smoke detectors and audible alarms. Facility has 1 fire extinguisher which is fully charged. Facility has supply of PPE. LPA observed facility has emergency food and water supply. Facility has required Emergency Disaster Plan posted. 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 a designated visitation area. No deficiencies noted during todays visit. An exit interview was conducted with Administrator Amy DeBoom and a copy of report was left at facility.