Routine inspection·March 23, 2023

Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct an Annual Required inspection and met with Administrator, Aira Monte. There is a total of 6 residents, 2 under hospice care. Upon arrival, LPA observed that staff continue to wear masks per current guidance. LPA initiated a tour of the facility at approximately 9:15 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents rooms were furnished per regulation. Water temperature in bathrooms measured at 110.8 , 112.6, and 113.3 degrees F which is within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cabinet containing cleaning supplies was locked. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Fire extinguisher was last inspected February 20, 2023. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational. Five staff five resident files were reviewed. All staff reviewed has current CPR and 1st Aid training Certification.Administrator Certificate for Administrator Aira Melanie U Monte 6056005740 expires 08/29/2024. Medications and medication records were reviewed. Administrator and lPA discussed their Emergency Disaster Plan and Infection Control Plan. There were no deficiencies cited at this time. Continue on LIC 809-C Licensee/Administrator to submit updates of the following documents by 4/13/2023 to SRRO: LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changes) LIC 9020 Register of Facilities Residents Infection Control Plan (If changes) Current Administrators Certificate Liability Insurance