Routine inspection·October 21, 2021

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 10/21/21 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with staff 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 and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was temperature screened by licensee upon entering the facility. Administrator is present at the facility. LPA toured the interior and exterior of the facility together with licensee 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: more thorough documentation of symptom screening for residents, staff and visitors; documentation is maintained for required testing; fit testing be done for proper fitting N-95s; and, LPA will arrange supply of N-95s for licensee pick-up at the RO. LPA requested: resident roster, LIC 500, Administrator's Certificate and signature page of the LIC 610E- emergency plan. copy of Liability Insurance provided. Documents to be submitted to LPA via email by 10/28/21. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.