Routine inspection·July 7, 2021

Licensing Program Analyst (LPA) Konnor Leitzell arrived at the facility unannounced on 07/07/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with Sherri Day (Staff) and explained the purpose of the visit. At that time, Sherri contacted Brenda Myers (Admin) to come to the facility to assist with the annual inspection. Prior to initiating the 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. Additionally, LPA was screened by Sherri and answers were documented in their visitor screening log. LPA and Brenda Myers toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, six (6) of six (6) resident bedrooms, four (4) of four (4) bathrooms, kitchen, garage, activity/storage, staff office/laundry room and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and admin completed the infection control domain and facility was found to be in substantial compliance at this time. 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.