Facility Evaluation Report

Licensing Program Analysts (LPA) Norman Woodridge conducted an unannounced visit to the facility to conduct a case management visit and to review Coronavirus 2019 (COVID-19) mitigation plan. LPA stated the purpose of the visit, was granted entry by staff 1 (S1), and went through screening procedure upon entering the building.

LPA conducted a tour of the inside and outside of the facility. No deficiencies were noted. LPA spoke to Staff 2 (S2). LPA discussed Provider Information Notice 21-38-ASC: Update Guidance for the Use of Masks, Surgical Masks, Respirators Related to Coronavirus Disease 2019 (COVID-19). LPA discussed Covid-19 Mitigation Plan with S2 and requested a copy of the completed LIC 808 form. A copy of PIN 21-38-ASC was given to S2.

No deficiencies were noted and citations were not issued.

LPA Norman Woodridge conducted an exit interview with S2 and provided her with a copy of this report.