Routine inspection·September 30, 2021

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Norman Woodridge for the purpose of conducting a Covid-19 Annual Inspection. LPA completed temperature screening upon entry into the facility. LPA met with Administrator (AD) Francis Mejia and discussed the purpose of the inspection. During the inspection, LPA and Staff 1 (S1) conducted a tour of the inside and outside of the facility, common areas, resident rooms, garage, and kitchen. LPA observed the following: There were 2 staff and 4 residents present at the facility. Resident rooms were clean and organized. LPA observed a 2-day supply of perishables and a 7-day supply of non-perishables. LPA observed hallways and walkways that were free of obstruction. LPA observed Covid-19 related posters in rest rooms, common areas, and on the outside of the facility. LPA reviewed Covid-19 related training signature sheet, mitigation plan, staff roster, and resident roster. LPA and AD discussed Provider Information Notice 21-38-ASC: Update Guidance for the Use of Masks, Surgical Masks, Respirators Related to Coronavirus Disease 2019 (COVID-19). No deficiencies were noted during the inspection. An exit interview was conducted with AD and a copy of this report was provided.