Routine inspection·November 16, 2021

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced onsite one-year infection control annual visit to the above-named facility. LPA met with Asel Dzheentaeva-Telman, Administrator and explained the purpose of the visit. Entrance interview conducted. The facility has submitted a Mitigation Plan to the Department. The facility has an entry station at the front door. Upon entry, staff, visitors, and clients who have returned from an outing are required to sign-in, complete a symptom questionnaire, and have a temperature screening. All documentation is kept in a binder near the main entrance. The entry station has PPE gear consisting of masks, gloves, gowns, thermometer, hand sanitizer, and disinfecting wipes. LPA conducted a physical tour of the facility. A walkway to the front door is the main entrance into the facility. The facility consists of a: Living room, dining area, kitchen, four bedrooms (two private and two shared), a locked staff room, laundry area, and a locked garage. Laundry supplies and equipment are kept in the locked garage. Residents' bedrooms have a bed, mattress, nightstand, chair, dresser, and closet. Overhead lighting and lamps provide sufficient lighting in each bedroom. Bedrooms 1 and 2 are shared bedrooms with a private bathroom in each bedroom. Bedrooms 1 and 2 have an outdoor exit with an alarm. Bedrooms 3 and 4 are private bedrooms with one shared bathroom. The backyard consists of a covered porch, sitting area, and a swimming pool in a locked fenced area. The resident records and staff records are kept in a locked kitchen cabinet. First Aid kit(s) and medications are kept in a locked cabinet located in the kitchen. LPA observed smoke detectors and carbon monoxide detectors are hard-wired and directly connected with the local fire department. Fire extinguishers were serviced on 3/3/2021. Fire clearance is approved for 6 non-ambulatory residents of which 2 may be bedridden. Emergency food, water, emergency PPE gear is kept in the locked garage. Exit interview conducted, no citations issued. Copy of report issued via email.