Routine inspection·October 27, 2021

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 10/27/21 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Administrator and explained the purpose of the visit. Prior to initiating the annual 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. LPA completed a facility risk assessment upon arrival. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility. Administrator is present at the facility to conduct an annual inspection. 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, Administrator, and Infection control Leader completed the infection control domain and facility was found to be in substantial compliance at this time. LPA advised the following: screen and document all staff, residents and visitors symptom screening and Fit Test N95s for staff prior to quarantines (if needed). LPA offered N-95s, gowns and face sheilds for facility to pick up at the regional office. LPA received and updated facility sketch LPA requested: a copy of Resident Roster, LIC 500, Administrator's Certificate, signature page of LIC 610E- emergency/disaster plan and Liability Insurance. Documents to be submitted to LPA via email by 11/3/21. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.