Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPAs met with Administrator Hiransha Keerthisinghe and explained the purpose of the visit. There are 6 residents ages 60 and above. The The facility has a Dementia Waiver in place. A hospice waiver for 4 residents is in place. The facility is a single story home located in a residential neighborhood that is licensed for 6 non-ambulatory residents, of which 1 may be bedridden. It consists of 4 bedrooms, 2 bathrooms, living room, family room/dining area, kitchen, outdoor covered patio, and a detached garage with laundry area. The last fire drill was conducted on 1/20/22. Administrator certificate expires 10/9/2021.

COVID-19 Infection Control screening and signs were observed in the entrance, common areas, hallways, and bathrooms. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. No health and safety issues were observed.

Facility has an approved COVID-19 Mitigation Plan.

Room #4 has been designated as a COVID-19 solation room if needed.

Three (3) centrally stored resident medication records were reviewed.

Staff were observed wearing a surgical mask.

Residents in care were not observed wearing masks, as it is not tolerated due to health issues.

Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.

A posted Emergency Disaster Plan was observed.

Sufficient supply of Personal Protective Equipment (PPEs) was observed.

Staff and resident files were not reviewed during today's visit.

Exit interview was conducted with Administrator Hiransha Keerthisinghe . A copy of the report was issued.