Facility Evaluation Report

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 02/25/2022 at 10:40am. LPA met with facility Administrator Megan Miller (Admin). LPA toured the facility, including front office, medicine room, kitchen, dining room, living room, 1 bathroom, 2 resident rooms, and back patio.

All staff members observed to be wearing masks. All residents in facility observed to be wearing masks. Admin confirmed that all residents and staff have been vaccinated. Facility Mitigation plan has already been submitted and approved. No prohibited items noted in resident rooms. All emergency exits noted to be clear of obstruction. All rooms in facility noted to be clean and well maintained. Facility noted to not have N95s stored within the building, they are instead located in WRC-1 across the street.

Facility observed to have designated entry point. Staff took LPA's temperature, and screened for symptoms. Facility bathrooms not noted to have hand washing signs. Facility isolation area noted to not have an area for PPE donning and doffing. Facility only has one staff member working in the facility, who would be interacting with both COVID positive and COVID negative residents.

LPA observed locks on refrigerator and freezer.

Advisory notes were issued. See LIC 9102. Deficiency cited during visit. See LIC 809-D. This report reviewed with Administrator Megan Miller and a copy of the signed report was provided.