Routine inspection·July 29, 2021

On 7/29/21 Licensing Program Analysts (LPAs) Praveen Singh and Danyle Wolter arrived unannounced to conduct an annual required inspection utilizing the infection control domain. LPAs met with Administrator John Butuza and explained the purpose of the inspection. Prior to initiating the annual inspection, LPAs completed required COVID-19 testing protocols, daily self-screening questionnaires for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 masks. LPAs toured the facility inside and out including but not limited to living room, dining room, kitchen, bathroom, resident rooms, garage & outside areas. Facility has enough supplies of PPE, paper supplies and hygiene supplies. Medications are centrally stored in a locked area that is inaccessible to residents and refilled every 30 days. Facility has enough 2-day perishable and one-week non-perishable food supply. Visitors policy is posted on the front entrance. There is one central entry point for universal screening for staff, residents and visitors. Updated copies of the following documents were requested for facility file and are to be sent to CCL by 08/5/21: • LIC808 - Mitigation Plan • LIC500- Personnel Report • LIC308- Designation of Facility Responsibility • LIC610E- Emergency/Disaster Plan • Evidence of Liability Insurance LPAs and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time, screening policies were discussed and are to be implemented. No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of report left at the facility.