Facility Evaluation Report

Licensing Program Analyst (LPA) Janira Arreola, made an unannounced visit to the facility for the purpose of conducting an annual focused on infection control. LPA was greeted by facility Administrator Pamela Lyles, who was informed of the purpose of the visit.

LPA toured the interior and exterior of the facility. At the time of the visit there were 2 clients and 4 staff present. LPA observed COVID-19 postings at the facility, as well as a central entry point and sign in and screening process. LPA will issue technical advisory note for the facility to start documenting client and staff temperatures daily. LPA toured resident rooms which will be used as isolation rooms. LPA observed C1 had oxygen in his room, LPA will document Technical advisory note for oxygen no smoking sign, and fire department notification to be made. LPA observed a sufficient amount of paper towels, toilet paper, hand soap, and hand sanitizer in facility restrooms. LPA observed a sufficient supply of PPE equipment at the facility. LPA will document technical advisory note for staff to be trained in PPE usage and to be N95 FIT tested. There is a cleaning plan in place to disinfect the highly touched surfaces, and a plan in place to monitor the clients regularly for any changes in condition.

LPA was informed of the fact that C1 was admitted to hospice recently and observed client to have hospice bed and oxygen in their room. The facility currently does not have an approved hospice waiver issued by the department. LIC809-D will be document with Type B citation for this.

An exit interview was conducted where this report along with LIC9102TA and LIC 809-D forms were reviewed and provided to Administrator, Pamela Lyles.