Facility Evaluation Report

LPAs Lusby and Bains arrived on Thursday December 16, 2021 to conduct a case management visit due to an incident report received by the Department on 12/7/2021. 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.

LPAs discussed the unexpected death of R1 with Administrator.

LPA obtained copies of R1's physicians report, emergency identification sheet, care plan, ISP, and medication list. LPA requested Administrator obtain a copy of R1's death certificate and fax to the Department.

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