Routine inspection·November 8, 2021

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Anna Richards, caregiver, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA confirmed there are no residents or staff with a confirmed case or signs/symptoms or Covid. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA observed (3) residents to watching television or napping in the common area and (1) resident resting in her shared resident rooms. (1) resident was out of the facility with a family member at time orf inspection. LPA was advised there are no residents on hospice. LPA met with Administrator, Sam, who arrived shortly to the facility. LPA and caregiver toured the interior of the facility. LPA observed it to be clean and in good repair. LPA observed a few Covid posters throughout. LPA to e-mail additional posters, including one for cough etiquette and proper hand-washing. . Rooms toured include (4) private bedrooms, (1) shared rooms, , (3) bathrooms, kitchen, laundry area and common areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 72* F. LPA observed sufficient 2+day perishable and 7+day non-perishable food. LPA observed paper towels, soap and sanitizer. Administrator to place a trash can with lid and hand-washing poster in the bathrooms. Discussed vaccination status of residents and staff. Current copy of Administrator certificate to be posted. Fire extinguisher serviced last week- to provide confirmation as service company did not update tag. Discussed staff and visitors wearing masks at all times, even if fully vaccinated. LPA was provided with a copy of completed Mitigation Plan that was provided to the Department on/around January 2021 when due. There were no deficiencies observed during today's inspection. LPA requested updated copy of liability insurance and LIC308. Exit interview. Copy of report to be e-mailed to facility.