Routine inspection·September 8, 2021

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Arlene Henry, caregiver, and explained purpose of inspection. LPA spoke to Administrator, Nelson, by phone, who was at a related facility and unable to come to this facility during the time of the inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, contacted the facility to confirm there are currently no positive Covid-19 diagnoses, completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms Additionally, LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and was requested to do so also upon entering the facility. The following Personal Protective Equipment (PPE) was worn: surgical mask. LPA observed (2) residents sitting in the family room and (4) residents to be in their rooms. There are no residents currently receiving hospice services. LPA and Administrator toured and observed the facility to ensure the health and safety of residents in care. Areas toured include, but are not limited to: common areas,(2) private bedrooms, (2) shared bedrooms, (2) bathrooms, dining room and kitchen. LPA discussed how beds in shared rooms need to be 6 feet apart or 6 feet apart diagonally, from head to toe orientation. LPA observed 2+day perishable and 7+day non-perishable food supply. PPE supply for 30+ days on hand. In the areas toured, there were no immediate health, safety, or personal rights violations 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 75* F. Caregiver advised that staff document daily staff temperatures. LPA requested updated copy of LIC500, LIC610E and liability insurance be faxed to the department by 9/15/2021. Discussed current testing requirements. All staff and residents are currently fully vaccinated. There are no deficiencies cited during today's inspection. Exit interview with caregiver who was authorized to sign today's report. Copy of report left at facility.