Routine inspection·June 9, 2021

Licensing Program Analyst (LPA) Konnor Leitzell arrived at the facility unannounced on 6/9/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with Reva Radway (Staff) and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; and asked facility staff risk assessment questions. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. Additionally, LPA was screened by Colletta Salmon (Staff). LPA and staff toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, five (5) of five (5) resident bedrooms, four (4) of four (4) bathrooms, kitchen, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Mihnea Manghiuc (Admin Husband) completed the infection control domain and facility was found to be in substantial compliance at this time. LPA is to send facility information regarding PIN 21-28ASC and Fit Testing resources. LPA is requesting the following documents to be submitted to CCLD by COB 6/18/2021: Designation of Administrative Responsibility (LIC 308); Personnel Report (LIC 500); Proof of Liability Insurance. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.