Routine inspection·July 8, 2021

Licensing Program Analyst (LPA) Konnor Leitzell arrived at the facility unannounced on 7/8/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with Brenda Myers (admin) 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; 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: N-95 Masks. LPA and Brenda toured facility together to ensure no clients were in care. LPA was informed facility currently has a census of zero (0) due to current renovations. Areas toured include but are not limited to: common areas, five (5) of five (5) bedrooms, two (2) of two (2) bathrooms, kitchen, and backyard. In the areas toured no residents were seen to be in care. LPA and admin completed the infection control domain and facility was found to be in substantial compliance at this time. Admin indicated facility will remain closed until renovation are completed. LPA is requesting the following documents to be submitted by COB 7/23/2021 via fax at (916) 263-4744: Designation of Administrative Responsibility (LIC308); Personnel Report (LIC 500); Control of Property; Limited Liability Insurance. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.