Facility Evaluation Report

9/27/2021 9:30 AM Licensing Program Analyst (LPA) Dawn Keane arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain .LPA met with Instructor (IN) Christine Wade 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; contacted administrator Melissa Martin and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and

the following Personal Protective Equipment (PPE) was worn: N95. Additionally, LPA Keane was screened by IN. LPA Keane and IN toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, bathrooms, isolation room, and storage areas. In the

areas toured no immediate health, safety, or personal rights violations were observed. Keane and the IN 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 given to IN