Routine inspection·December 8, 2021

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Administrator, Cornelia Cata and explained purpose of inspection. Prior to initiating today's inspection, 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 community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Facility currently has (4) residents and (0) residents are on hospice. LPA observed (3) residents to be in the common area watching television and (1) resident to be resting in her room. Caregiver, Madaline Cata, was also present, and indicated she is waiting to receive her Administrator Certificate from the Department after completing her initial (80) hours. LPA and Administrator toured the interior of the facility, including (6) private resident rooms with a half bath each, kitchen, laundry, caregiver room, office and common areas. 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 Administrator 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 1/14/2021. 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. 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. LPA observed signage/information posted at 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 (copy printed) and current liability insurance be provided to the Department by 12/15/2021. . Photo of updated Administrator certification taken during inspection. There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator.