Facility Evaluation Report

At approximately 12:35 PM on 02/03/22, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection using the Infection Control Domain of the Compliance and Regulatory Enforcement (CARE) Tools. LPA met with staff and later Administrator and disclosed the reason for the visit.

Entry: LPA observed a sign posted on the front door regarding the facility’s visitation policy and COVID precautions. The walkway and front yard were well maintained.

Screening: Staff took LPA’s temperature and requested LPA sign in on the visitor log. LPA recorded name and time of arrival. LPA recommended two additional columns for visitor temperature and symptom check. LPA also observed gowns, N95 masks, surgical masks, surgical masks, gloves, and sanitizer. Beside the visitor log was a binder for daily documentation of resident temperatures.

At approximately 12:55 PM, LPA conducted a physical plant tour.

Bedrooms: The facility has 6 bedrooms in total. 1 bedroom is shared, and 5 bedrooms are private. All bedrooms were clean and odorless. Furniture was in good repair. Bedroom #1 was the shared bedroom. It contained a secured partition which provided social distance between beds. Bedroom #3 was designated for a bedridden resident, and the emergency exit was free from obstruction. Bedroom #4 also contained a secured partition but contained only one resident. Two other bedrooms were designated for staff and an individual who was fingerprinted and criminal background cleared.

LPA observed a locked closet in a hallway amongst Bedrooms #1, #2, and #3. The locked closet contained medication and extra hygiene supplies.