Facility Evaluation Report

On 10/14/21 at 12:30 PM, Licensing Program Analyst (LPA) Cheng conducted an unannounced required 1-year annual inspection and met with Administrator Gladys Gasta. Prior to initiating 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; contacted Administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask and gloves. Additionally, LPA was screened by Gasta.

LPA Cheng toured the facility inside and out including but not limited to facility front entrance, living room, bathrooms, kitchen area, outside area, outside resident bedrooms, and storage rooms. All passageways are free of obstruction. All staff were observed to be wearing surgical masks. Facility entrance is equipped with proper COVID-19 signage and screening station. Facility has a mitigation plan in place should a COVID positive case occur. Facility has sufficient supply of perishable food, non-perishable food, medication, and PPE.

LPA Cheng completed infection control domain and observed no issues or concerns. No deficiencies observed.

Exit interview conducted and a copy of report was provided.