Facility Evaluation Report

On 12/22/22, Licensing Program Analysts (LPA) M. Medina arrived at the facility unannounced to conduct a annual infection control inspection. LPAs were greeted by House Manager, stated the purpose of the visit and were allowed entry into the facility. COVID precautionary measures were taken at the time of entry. Front door is facility main entry point, LPA observed the Staff and Visitor sign in and COVID Screening area.

Facility Mitigation plan has been submitted to CCL. Infection control procedures described in the plan which were observed and reviewed by LPA include: Daily symptoms screenings (for staff, persons in care and visitors), testing, visitation , quarantine/isolation procedures, emergency staffing plan, PPE storage, use and training, as well as daily infection control procedures. Administrator is identified as the Infection Control Lead for the facility.

LPA toured the facility inside and out. Postings to encourage face coverings and hand washing were observed. Furniture in common and dining areas are spaced to promote distancing. Staff were all observed wearing face coverings. Facility has multiple designated visitation areas available. LPA observed 30-day medication supply and PPE accessible to staff. Common and resident bathroom sinks are stocked with liquid soap and paper towels for hand washing.

Through LPA’s observations, documentation review and interview with Licensee, the required infection control practices are found to be in compliance. No deficiencies cited on todays visit.