Routine inspection·December 23, 2021

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with caregiver, Valentina Kovalova, who contacted the Administrator, Sam, by phone. LPA met with Jennifer Toplean, Co-Administrator, who arrived to the facility at 11:30 am. 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 (6) residents and (1) resident is on hospice. LPA observed (1) resident to be watching television in the common area and (5) residents to be resting in their rooms. A second caregiver, Maureen Green, was also present during the inspection. LPA and caregiver toured the interior of the facility, including (6) private resident rooms, (2) resident bathrooms, kitchen, laundry, caregiver room, 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 Co-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 10/29/2021. 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 issued 8/27/2021. LPA observed signage/information posted at the front entrance that masks are required upon entry. LPA requested an updated copy of LIC308, LIC500 and current liability insurance be provided to the Department by 12/31/2021. There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Co-Administrator.