Routine inspection·November 8, 2021

Licensing Program Analyst (LPA) K. Hiratsuka, arrived at the facility unannounced on 11/08/2021 to conduct an unannounced annual visit using the infection control tool visit. LPA met with Facility Caregiver Maria Zdagat and explained the purpose of the visit. Prior to initiating the visit, 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; contacted Facility Administrator and completed a facility risk assessment. LPA ensured they washed hands just after entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Caregiver. LPA and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, and common restrooms.. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Caregiver completed the infection control domain and facility was found to be in substantial compliance at this time. A couple of topics were discussed during today's visit. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.