Routine inspection·June 10, 2021

Licensing Program Analyst (LPA) K. Hiratsuka, arrived at the facility unannounced on 06/10/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Facility Representatives Melissa Johnson and Austin Watkins and explained the purpose of the visit. Prior to initiating the prelicensing visit, 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; contacted Facility Representative 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 screened by Melissa Johnson. This facility has a fire clearance for two ambulatory and two non-ambulatory residents. To the right of the main entrance is a sitting area. To the left of the main entrance is a hallway that leads to three private resident rooms and two full common bathrooms. Two of the bedrooms in the hallway have exits to the outside. The back of the facility has the main sitting, dining, and kitchen. Next to the ktichen has the forth private resident room. There is a a door leading to the garage from the kitchen. The backyard was inspected and the gate is on the same side as the garage. Several topics were discussed as well as infection control. The following needs to be updated and submitted to CCLD by the end of June 2021: LIC 500 facility personnel or staff schedule LIC 308 designation of administrative responsibility. letter stating who the current administrator is. a copy of the control of property No deficiencies cited.