Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang and Program Clinical Consultant (PCC) Helen Shi conducted Technical Assistant PCC through tele-inspection, and met with Administrator (ADM) Shirley Richards.

The purpose of this TA PCC Tele visit was to review the facility COVID-19 infection mitigation plan and conducted inspection of the facility to ensure plan is being carried out and to provide support and guidance to staff in mitigating the spread of virus.

During visit, a tour of the facility was conducted which started at the main entrance to check COVID-19 signage and screening procedures. The facility has the COVID-19 posters at the main entrance to include screening questionnaire forms, hand sanitizer, face masks, glove, and a visitor log book.

The facility common areas were inspected such as the kitchen, living room, dinning room, bathrooms were observed. There are 6 resident bedrooms, 1 staff live-in bedroom, and 2 and half bathrooms in facility.

Facility bathrooms signage on hand washing, hand sanitizer, paper towel were observed, and trash cans with covers were observed. The laundry room was observed and inspected. ADM stated the dining area only allows two people to stay at one time. ADM stated the positive resident (R1) is isolating at R1's family home, and R1 will stay at R1's family home at least one more week. ADM stated all the residents have the single room.