Pre-licensing visit·February 2, 2022

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility announced on 2/2/22 to conduct a Pre-licensing referencing the infection control domain. LPA met with staff designee and explained the purpose of the visit. Prior to initiating the prelicensing 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 entering the facility. Administrator is not present at the facility. 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 advised a more robust lock on the knife drawer and kitchen sink cabinet, locking the outdoor shed when not in use and that all toxins and chemicals be secured from residents. LPA and Denisa completed the infection control recommendations and facility was found to be in substantial compliance at this time. LPA advised staff wear masks at all times at work and record of weekly testing of unvaccinated staff be maintained in staff files as needed. LPA reviewed one resident and one staff file. Both had required forms. Staff training records not present. LPA requested licensee submit proof of staff training. LPA will check with fire inspector for approval of fire door and door magnet holder. Component III review not completed. No deficiencies are being cited as a result of todays inspection. LPA will follow-up with Licensee that advised issues were addressed. LPA to conduct follow-up visit. Exit interview conducted and copy of report left at the facility.