Routine inspection·November 2, 2021

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with administrator Lucian Mititi during today's 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 ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks. LPA toured facility with administrator to ensure health and safety of residents in care. LPA toured 6 resident rooms, 1 staff room, 6 bathrooms, kitchen, common living spaces, backyard and the garage area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA observed 2-day perishable and 7-day non-perishable amount of food present in facility. Administrator stated there has been no positive COVID cases at the facility, but have sufficient amount of PPE. LPA and admin completed the infection control domain and facility was found to be in substantial compliance at this time. Administrator to send into CCL LIC500, updated LIC308, updated administrator certificate, and liability insurance into CCL by 11/20/21. No deficiencies are being cited as a result of todays inspection. Exit interview conducted.