Facility Evaluation Report

11/22/2021 11:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a case managment investigation. LPA met with administrator Eric Perry and explained the purpose of the visit. Prior to initiating the complaint investigation 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 administrator 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: N95 mask, gloves.

The reason for the visit is an incident report that was received on 11/09/2021, in which it was reported that a staff person had slapped and threatened a resident.

LPA requested copies of the following documents: Staff list with phone numbers, Resident's Physician's Report and admission agreement. More investigation and interviews are necessary.

No deficiencies were cited during today's visit. An exit interview was conducted, and a copy of the report was emailed to administrator Eric Perry.