Routine inspection·May 31, 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 by staff and explained the reason for the visit. During the visit LPA toured the facility with Caregiver Sandra Mattis. Facility is a 7 bedroom (6 resident rooms, 1 staff room) and 3 bathroom single story home. There are 3 Residents in care. LPA observed proper department postings near front entrance of facility as well as sign in temperature check station. LPA observed copy of Administrators Certificate expiring 8/20/2023. LPA toured all Residents rooms, all rooms contained required furniture per regulations. All restrooms observed contained a working wash basin, soap, toilet paper and paper towels. LPA observed an outside visitation area with ample seating and shading. Residents were observed relaxing inside bedrooms watching TV. Facility has smoke detectors and 1 fire extinguisher which is fully charged and mounted. Facility has emergency food and water supply. Facility has 2 fridges and pantry with perishables and non perishables. Facility has required Emergency Disaster Plan posted inside facility. Facility has a secured location for resident medication and files. Residents have a 30 day supply of medications. Facility has a secured location for toxins and hazardous supplies. LPA reviewed resident files. LPA observed 3 of 3 resident files. Resident files have updated Emergency contact info and Physician's reports. LPA observed facility does not have 30 day PPE supply and discussed the importance to staff about maintaining supply. No deficiencies noted during todays visit. An exit interview was conducted with Caregiver Sandra Mattis and a copy of this report was left at facility.