Routine inspection·September 29, 2021

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 9/29/21 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with 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 contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility. LPA requested for staff to notify Administrator that LPA is present at the facility to conduct an annual inspection. Administrator arrived to assist with the visit. LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and designee completed the infection control domain and facility was found to be in substantial compliance at this time. LPA advised the following: more robust symptom screening, posting of coug/ sneeze etiquette and ensure all staff have fit tested N-95s. LPA requested: Resident Roster, LIC 500, Administrator's Certificate, last page (signature for annual review) LIC 610E and Liability Insurance. Documents to be submitted to LPA via email by 10/6/21. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.