Facility Evaluation Report

On 8/31/2021 at 3:00 PM Licensing Program Analyst (LPA) L. Ibo arrived unannounced to conduct an annual required inspection. LPA met with nurse Adrian Vierness. Facility Administrator is on leave. Facility has census of 3 . Facility is on yellow zone during the visit per local public health and nurse Adrian V.

LPA toured the facility inside and out including but not limited to common areas, resident rooms, bathrooms, kitchen and patio. No bodies of water. Facility has enough supplies of PPEs, paper supplies and hygiene supplies. Medications are centrally stored in a locked area that is inaccessible to clients and refilled every at least 30 days.

Facility has enough 2-day perishable food and one-week non-perishable food supply. Visitors policy is posted on the front entrance. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Facility staff were observed to be wearing proper PPE . Facility has a mitigation plan and maintains record of routine screening for residents and staff.

Exit interview conducted. Appeal Rights and copy of this report provided.