Routine inspection·July 21, 2021

Licensing Program Analyst (LPA) Wolter arrived at the facility unannounced on 07/21/2021 to conduct a Required - 1 Year Inspection utilizing the infection control domain. 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. LPA also contacted administrator and completed a facility risk assessment prior to inspection. LPA applied hand sanitizer prior to entering the facility and wore the following personal protective equipment (PPE) during today's visit: surgical mask. LPA met with administrator Johnny Nagy and explained the purpose of the visit. LPA and administrator toured the home together, areas toured include but are not limited to: common areas, kitchen, resident bedrooms, bathrooms, and outdoor area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and administrator completed the infection control domain together and facility was found to be in substantial compliance at this time. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at facility. Administrator to send Community Care Licensing (CCL) updated copies of LIC 500 - Personnel Report, LIC 808 - Mitigation Plan, and LIC 308 - Designation of Facility Responsibility by 07/28/2021.