Facility Evaluation Report

01/26/2022 1:30 PM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with licensee Ann Coffman and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask, gloves. Additionally, LPA Knight was screened by Ann Coffman licensee.

LPA Knight and Mrs. Coffman toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, two (2) resident bedrooms, two (2) bathrooms, kitchen, and storage areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Knight and the licensee completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection. Technical assistance was provided.

Exit interview conducted and copy of report was emailed to licensee Ann Coffman.