Routine inspection·November 5, 2021

On November 5, 2021, at 10:10am, Licensing Program Analyst, LPA DeAnna Williams-Lyons arrived unannounced to conduct a required annual inspection. LPA met with Natalie Oaksha , Administrator, and informed her the reason for the visit. Prior to initiating the 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 completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: mask. LPA completed the inspection tool questionnaire with Natalie with no issues or advisories to report. LPA observed the following: This is a 4 bedroom 2.5 bathroom home. Administrator certificate is valid and expires 4/10/2022 . First aid kit fully stocked and ready for emergency use. Fire extinguishers fully charged. Smoke alarms and Carbon Monoxide detector are working Hot water temperature is in the proper range. The facility temperature is 76 degrees F. Common areas were clean and in good repair. Bedrooms had required furniture and lighting. Facility has the required (2) day perishable supply of food and (7) supply of non-perishable food. Medication was properly stored and locked away. There are no bodies of water on the premises. To continue see 809-C... LPA reviewed 1 staff file and 1 resident file. Staff files have all the proper signatures and the facility is conducting training as required. Resident files also had all the required documents with the proper signatures. As a result of this visit, no deficiencies were cited, per Title 22 Regulations, Division 6. Administrator shall submit the following documents to update the Regional Office files: The documents shall be submitted to Community Care Licensing by 12/05/2021: -LIC 500 facility personnel or staff schedule -LIC 610 emergency disaster plan -LIC 308 designation of administrative responsibility -copy of liability insurance -updated facility sketch Exit interview conducted and a copy of this report given to Natalie.