Follow-up on corrections·September 27, 2023

Licensing Program Analyst (LPA) Darius Williams conducted an unannounced visit to the facility. LPA Williams met with Administrator Jason Johnson and discussed the purpose of the visit. LPA Williams reviewed resident files. Resident 1 and Resident 2 have restricted health conditions. LPA Williams interviewed the Administrator and reviewed employee files. LPA Williams did not observe any training records conducted by a licensed skilled profession, in the file, pertaining to general or specific procedures regarding R1 and R2's Restricted Health Condition. Administrator reported prior staff may have received training. Administrator reported he is going to partner with R1 and R2 primary care physicians or Home Health Agency to assist with training. Based on record review and interview, a deficiency is being cited on the attached LIC 809D page. POC was discussed with Administrator. An exit interview was conducted and a copy of this report will be provided via e-mail.