Facility Evaluation Report

Licensing Program Analyst (LPA) Vicky Williamson and Licensing Program Manager (LPM) Simon Jacob conducted an unannounced Required 1 -Year Visit. LPA and LPM were greeted and allowed entry by Patrick Pagtolon-An, LVN, identified themselves, and discussed the purpose of the visit.

LPA and LPM conducted a tour of the facility with Patrick Pagtolon-An, LVN. In accordance with the Department’s Infection Control program, LPA provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan (LIC 808).

LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; A sign-in policy enacted for all visitors; Face coverings worn by staff; Hand sanitizer/hand washing stations readily available; A designated visitation area; Emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE (Personal Protective Equipment). Based on observations, the facility is in compliance with and has implemented infection control practices as outlined in its LIC 808. No deficiencies were observed during today's visit.

An exit interview was conducted with Patrick Pagtolon-An, LVN, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.