Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility and explained the reason for the visit. Administrator Dora Fredericksen arrived during the visit. Administrator Fredericksen has a current administrator certificate expiring on 11/04/2021.

At 10:22 AM, LPA toured the facility with Caregiver Jiyasmin Coruna. Facility has 6 clients in care during today's visit. LPA observed clients relaxing in the facility. All clients appeared happy, well taken care of, and engaged with LPA. Facility appears clean and sanitary. All client rooms had the required elements as well as restrooms stocked with soap/ sanitizer. Four rooms are single occupancy and one is double occupancy. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the facility. Facility utilizes a visitor sign in sheet. Facility takes client and staff temperatures daily and documents. Facility has covid precaution postings as well as department postings. LPA observed the first aid kit has all required items. Facility mitigation plan has been approved. LPA observed an ample supply of emergency food and water. LPA toured the outside grounds and observed the outside visitation area. Exit gate is unlocked and self latching. LPA observed the locked medication storage area. Facility has a plan for covid testing clients and staff as needed as well as a plan for isolation and quarantine. LPA reviewed six client files during the visit and all files are up to date including emergency information. All clients and staff are vaccinated for Covid-19.

LPA consulted with Administrator regarding the importance of documenting all visitor temperatures upon entry into the facility.

No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.