Facility Evaluation Report

11/08/2021 1:10 PM Licensing Program Analyst (LPA) Dawn Keane arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain .LPA met with Administrator (AD) Teresa Vargas 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 AD 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. Additionally, LPA Keane was screened by AD.

LPA's Keane and AD toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, three (3) bathrooms, isolation room, and storage areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Keane and the AD completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report was given to AD.