Facility Evaluation Report

LPA Lusby arrived on Monday November 22, 2021 to further gather additional information regarding an incident that occurred on November 17, 2021. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. LPA was screened by staff prior to entry.

LPA interviewed Administrator Howard Huntsberry over the phone. Administrator agreed to email LPA a copy of the staffing schedule pertaining to R1. LPA obtained copies of R1's client chart documents. LPA interviewed staff regarding R1. LPA toured client's room at the facility.

Exit interview conducted. A copy of this report was left at the facility.