Routine inspection·December 31, 2021

**Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to copy/paste the report for the annual conducted on 12/10/2021 into this report (Annual/Random) so the annual inspection will be reflected in the system. LPA met with Lyndee Whaley, Administrator and explained purpose of inspection. LPA followed Covid-19 protocols below prior to today's inspection. ** Licensing Program Analysts (LPA's) Sabrina Calzada and Cassie Yang, arrived unannounced to conduct a required annual. LPA met with Lyndee Whaley, Administrator and explained purpose of inspection. LPA's were not able to choose a required annual as an option (only annual continuation), so the inspection domain tool was not accessible. LPA's completed required COVID-19 testing protocols and completed daily assessment and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA's were 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 surgical mask. The facility is approved for (74) residents and has a hospice waiver for (14). The facility has an approved mitigation plan. LPA's and Administrator toured the interior of the facility including the Assisted Living Unit, Memory Care Unit, main kitchen, medication room and common areas including the lobby area. In areas toured, LPA's observed the facility to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed various Covid posters, sanitizer and PPE throughout the building. LPA's observed paper towels, soap and hand-washing poster in restrooms and the facility will ensure all restrooms have a trash can with lid. Inside temperature was observed to be 76* F. Fire extinguishers last serviced 9/23/2021. LPA's observed 2+day perishable and 7+day non-perishable food and all sharps and toxins to be locked. LPA's and and Administrator discussed the vaccination status of residents/staff as well as visitation protocols per PIN 21-40. Administrator to post signage a the front entrance that masks, documentation of vaccination status or negative Covid test within 72 hours are required upon entry. LPA requested an updated copy of LIC308, current liability insurance during today's inspection by 12/17/2021. There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator who was informed that a subsequent annual inspection could be conducted on/around 3/29/2022.