Facility Evaluation Report

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. Upon entry LPA Gardner met with Caretaker Victor Vidrio who confirmed that there are currently no cases/exposures of COVID-19 within the facility. At the time of visit there were two (2) staff, and two (2) residents present. S1 spoke to LPA Gardner in broken English. S1 stated that they did not understand LPA Gardner. S1 requested that LPA Gardner speak into a cell phone on a translator application. S1 read the translator application, then spoke into the translator application to respond to LPA Gardner. LPA Gardner called the licensee and notified them they need to come to the facility to complete the visit or send another staff member who could speak to LPA Gardner with no communication issues. Licensee Na. Zhoa did not come to the facility, so LPA Gardner completed the visit with S1. The facility will be issued Technical Assistance Advisory note for not having someone at the facility capable of communicating without issues.

Upon observation and interview, LPA Gardner discovered that S2 is working at the facility without having criminal background clearance. S2 has been working at the facility for one (1) year. The facility will be issued a citation for S2 not having a criminal background clearance, as well as a $500-dollar civil penalty.

LPA Gardner requested to view staff files for S1, LPA Gardner was notified there was not a staff file for S1. The facility will be issued a citation for having a staff file for S1. S1 started creating a file during todays visit once LPA Gardner notified them it was needed for review.