Routine inspection·December 29, 2021

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with manager, Auruta Gimon and Administrator, Ioan Gimon. LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. Facility currently has (3) residents, none of whom are currently on hospice. (1) resident, who was on hospice, passed earlier this morning. LPA observed the mortuary representative arrive during the inspection and family members present also, wearing masks. LPA and manager toured the interior of the facility, including (5) private resident rooms, resident bathrooms, kitchen, common areas and caregiver rooms. LPA observed it to be clean and in good repair. LPA observed various Covid posters throughout. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and manager completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 73* F. Fire extinguisher last serviced 1/12/2021- to be re-serviced by 1/12/2022. LPA observed sufficient 2+day perishable and 7+day non-perishable food. LPA observed paper towels, soap, sanitizer and trash cans with lids in the bathrooms as well as PPE supply. Sharps, toxins and medications are secured appropriately. LPA and Administrator discussed vaccination status of residents and staff as well as visitation protocols per PIN 21-40 issued 8/27/2021. Testing requirements also discussed. The facility has not had any prior/current Covid cases. LPA was provided with a copy LIC500 and current liability insurance during today's inspection. There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to manager.