Routine inspection·August 24, 2021

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Simona Tif, caregiver/Co-Administrator. caregiver and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, contacted the facility to confirm there are currently no positive Covid-19 diagnoses, 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 ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical Mask. There are (6) residents at the facility. LPA observed (3) residents to be watching television in the main room and (3) residents to be resting in their rooms during the inspection. LPA and caregiver toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, (2) shared resident bedrooms, (2) private resident bedrooms, (1) resident restroom, (1) staff restroom, kitchen, dining room, and laundry area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food on site. LPA observed PPE supplies on hand to include: N95 masks, gowns, gloves and sanitizers. LPA and caregiver completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 77* F and fire extinguisher was last serviced on 7/14/2021. LPA requested updated copies of LIC500, LIC610E and copy of liability insurance- to be faxed to the department by 8/31/2021. Current testing protocols discussed for staff and copy of PIN 21-38 issued 8/19/2021 left at facility. There were no deficiencies cited as a result of todays inspection. Exit interview conducted with Simona, caregiver, and copy of report left at the facility.