Facility Evaluation Report

On 1-4-22 at 12:47pm, Licensing Program Manager (LPA) Michael Bilger arrived unannounced to conduct a case management visit for a facility reported incident which occurred on 12-22-21. LPA met with Assistant Administrator Alisha Hale and explained the purpose of the visit. Administrator Leah Zubiate was notified of LPAs visit and gave permission for Assistant Administrator to accommodate LPA and sign in her absence. The purpose of today's visit is to collect necessary documentation for investigation bureau. Documents requested included: Current resident roster, staffing schedule, Facility sketch, Administrator certificate, medication logs for resident1 (R1) and (R2), incident reports for R1 and R2, Admission agreements for R1 and R2, Physician's reports for R1 and R2, daily routine schedule, house rules, LIC 501 for staff1 (S1), S2, and S3, and mandated reporter forms for S1, S2, S3.

As a result of today's visit, no deficiencies are cited. An exit interview was held with Alisha Hale and a copy of this report was given to Alisha.