Facility Evaluation Report

Licensing Program Analysts Ryker Heberle and Mandeep Kaur (LPAs) conducted an unannounced annual inspection on 05/20/2022 at 01:55pm. LPAs met with facility Administrator Fredricka Safar (Admin).

LPAs toured the facility, including living room, kitchen, dining room, laundry room, 5 resident bedrooms, staff office/staff room, 2 bathrooms, and back yard. All staff members observed to be wearing masks. Admin confirmed that all staff and residents have been vaccinated.

Facility Mitigation plan has already been submitted. No prohibited items noted in resident rooms. All emergency exits noted to be clear of obstruction. All rooms in facility noted to be clean and well maintained. Hand sanitizers, soap, and paper supplies were observed to be available. At least 2 days' supply of perishable food and at least 1 week's supply of non-perishable food was observed on the premises. Recently purchased fire extinguishers observed within the premises. All cleaning supplies and chemicals noted to be in locked cabinets and closets. Smoke/carbon monoxide detectors were tested and observed to be operational.

Facility observed to have designated entry point. Staff did not take LPAs' temperature nor screen LPAs for symptoms. 30 days supply of PPE was not observed, as the facility did not contain gowns. Hand washing signs were observed in facility bathrooms. Water temperature observed to be 112.4 *F in facility bathroom. Social distancing signs observed to be posted in all public areas.

No deficiencies cited during today's visit. Advisory notes issued. This report was reviewed with Administrator Fredricka Safar, who gave staff member Teresita De Ausen verbal permission to sign on her behalf. A copy of the signed report was provided.