Routine inspection·June 22, 2021

Licensing Program Analyst (LPA) Wolter arrived at the facility unannounced on 06/22/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with administrator, Sita Vadarevu 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: N-95 Mask. Additionally, LPA was screened by facility staff upon entry. LPA and administrator toured the facility together to ensure health and safety of residents in care, areas inspected include but are not limited to: common areas, four (4) shared resident bedrooms and bathrooms, shower room, kitchen, med room, and outdoor patio area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and administrator completed the infection control domain together and facility was found to be in substantial compliance at this time. Administrator to send Community Care Licensing (CCL) updated copy of LIC 308 - Designation of Facility Responsibility, LIC 500 - Personnel Report, and current liability insurance by 06/29/2021. In the areas inspected, no deficiencies are being cited. Exit interview conducted and copy of report to be sent to administrator.