Facility Evaluation Report

LPAs Lusby and Bains arrived on Thursday December 16, 2021 to conduct the annual inspection. Prior to the visit, LPAs 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; LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

LPA and Administrator completed the infection control domain together. Facility was found to be in substantial compliance.

LPAs, Administrator, and Maintenance Director completed a facility walk through. No health, safety, or personal rights violations were observed.

LPA requested the following updated forms to be faxed to the office: LIC500, LIC610E, LIC308, and a copy of the current Administrator's certificate.

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