**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** D. Medication Pass: On 4/19/22 at 9:08 AM, an observation was made of LPN 1. LPN 1 dropped a sublingual medication film on the top of the medication cart. LPN 1 donned a glove, picked up the sublingual film and placed it in the medication cup that held resident 33's other morning medications. LPN 1 then administered all the medications to resident 33. On 4/20/22 at 8:25 AM, an observation was made of the ADON. The ADON placed his pointer and middle finger on the back side of resident 17's medication card. Each medication touched the ADON's fingers when pressed out of the medication card into the medication cup. The ADON administered the medications to resident 17. Hand hygiene was not used prior to medications being placed in the cup. On 4/20/22 at 8:35 AM, an observation was made of the ADON. The ADON placed his pointer and middle finger on the back side of resident 29's medication card. Each medication touched the ADON's fingers when pressed out of the medication card into the medication cup. The ADON administered the medications to resident 29. Hand hygiene was not used prior to medications being placed in the cup. Based on observation, interview, and record review it was determined that the facility failed to establish an infection prevention and control program designed to prevent the development and transmission of Coronavirus disease (COVID-19). Specifically, the facility failed to ensure that staff members were screened for COVID-19 prior to entering the facility to work. The facility failed to ensure a symptomatic staff member, who subsequently tested positive for COVID-19, was screened accurately and notification and evaluation was completed per the facility protocol. The failure resulted in 3 residents being exposed to COVID-19. After the staff member tested positive for COVID-19, the facility did not implement the use of additional personal protective equipment (PPE) for staff to decrease the spread of COVID-19. In addition, visitors were not screened for COVID-19 and were not provided PPE prior to entering the facility. In addition, facility staff did not use appropriate PPE when providing aerosol-generating procedures. These examples were cited at an Immediate Jeopardy (IJ) level. Staff members were observed to touch resident medications with bare hands and not perform hand hygiene during medication pass. Resident identifiers: 17, 29, 33, 50 and 53. Findings included: On 4/21/22 at 11:14 AM, an IJ was identified when the facility failed to implement Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) recommended practices to prevent the spread of COVID-19. Specifically, the facility failed to ensure employees and visitors were screened for COVID-19, facility staff did not use appropriate PPE during an outbreak, and staff did not use appropriate PPE during transmission based precautions for aerosol generating procedures during an outbreak. This resulted in three residents being exposed to COVID-19. Notice of IJ was given verbally to the Administrator, Director of Nursing (DON), and the Regional Nurse Consultant (RNC) and they were informed of the findings of IJ pertaining to F880. On 4/21/22 at 3:11 PM, the Administrator provided the following written abatement plan for the removal of the Immediate Jeopardy effective on 4/21/22 at 3:11 PM: Immediate Actions Taken to Correct Deficient Practices All employees and visitors currently in the facility have completed COVID-19 screening in accordance with facility policy and expectations. All employees have donned eye protection due to outbreak status as extended use PPE in addition to face mask for use when in resident rooms and resident common areas. 3 residents were identified to use devices that are aerosol generating:. Precaution carts with all necessary PPE for use during aerosol generating procedures have been implemented with visible signage posted communicating the requirement to utilize gloves, gowns, respiratory/N95 mask and eye protection when aerosol generating procedures are occurring. Measure to Ensure the Deficient Practice Does not Recur All employees have been in-serviced regarding requirements for COVID-19 screening of employees and visitors and PPE usage during an outbreak and during aerosol-generating procedures. Administrator has posted visible signage in conspicuous locations throughout the facility reminding employees and visitors of COVID screening requirements and reminding employees of PPE usage requirements. Administrator has scheduled a staff member to supervise the front entrance of the facility to ensure that all staff and visitors during business hours are screened for COVID-19 appropriately and designated the 200 hall nurse as the primary staff member responsible to ensure screening is completed outside of business hours. Administrator has implemented a COVID screening audit tool to be conducted at each shift change (0600 [6:00 AM] 1400 [2:00 PM], 2200 [10:00 PM]) daily x 2 weeks then at each shift change three times weekly x 4 weeks to ensure all employees have been screened for COVID-19 and to confirm that all visitors have been appropriately screened for COVID-19. Director of Nursing has implemented a PPE Usage Audit to be conducted on each shift (0600, 1400, 2200) daily x 2 weeks then at each shift change three times weekly x 4 weeks to ensure that PPE is being utilized in accordance with CDC, CMS and local department of health guidelines. Measure to Monitor and Ensure Corrective Action is Achieved and Sustained QAA [Quality Assurance and Assessment] committee under the director of the administrator will review the findings for COVID screening tool audit as well as the PPE Usage audit monthly until a lesser frequency is determined to be appropriate. Any ongoing problems with COVID screening and PPE usage process will be addressed with modifications to the plan of correction implemented at the direction off the QAA committee. Immediate Jeopardy A. Screening for staff and visitors: On 4/18/22 at 8:30 AM, an observation was made of the COVID-19 screening area at the front entrance. There was a binder with forms for visitor information. The binder had forms filled out and did not have blank forms. Licensed Practical Nurse (LPN) 1 was observed across the dining room. LPN 1 was observed to tell the surveyors to head to the conference room. The surveyors asked if there was anything that needed to be done before allowing the surveyors into the facility. LPN 1 sated oh yeah, sign in but LPN 1 was unable to find blank forms. LPN 1 located a form with columns for a name, time in, time out, and what resident the visitor was visiting. There was no information regarding where to document temperatures or if a visitor had signs or symptoms (s/sx) of COVID-19. LPN 1 was observed to make changes to the form and obtained surveyors temperatures. LPN 1 did not ask surveyors about s/sx of COVID-19. On 4/18/22 at 9:16 AM, an interview was conducted with the Administrator. The Administrator stated Certified Nursing Assistant (CNA) 3 tested positive for COVID-19 on 4/16/22. The Administrator stated that CNA 3 worked the 100 hall graveyard shift on 4/14/22 and 4/16/22. The Administrator stated that she received a text of a positive COVID-19 test from CNA 3 at about 10:30 PM on 4/16/22. The Administrator stated that CNA 3 was sent home. The Administrator stated they contacted the Healthcare Acquired Infection (HAI) team member and there were no residents with signs and symptoms. The Administrator stated CNA 3 had minimal contact because he was working nights so there was a lower risk. The Administrator stated that the HAI team member did not instruct for PPE changes for the staff. The Administrator stated that staff were to continue wearing surgical masks only and 3 residents were tested on [DATE]. On 4/18/22 at 9:56 AM, additional observations were made of the facility's COVID-19 screening area. It was observed that there was no staff member at the front entrance. A sign was observed on the wall by the screening station that listed the symptoms of COVID-19. A second sign was observed that stated, Please make sure to screen yourself BEFORE visiting your loved one. The visitor's log was observed to be on the table. It was observed that on the visitor log sheet, there was a place for visitors to put the date, their name, and their temperature. The binder for COVID-19 screening questionnaires for visitors was observed to be on the table. It was observed that a binder for employee screening was on the table. It was observed that in the binder that each employee had a sheet with their name and two calendars, one for April 2022 and one for May 2022. It was observed that employees were required to record their temperature on the calendar day they worked, and to circle either L for low risk or H for high risk. A flow sheet for COVID-19 screening was observed in the front of the binder that had questions to guide employees to determine if they were a high risk or a low risk for COVID-19. It was observed that surgical masks, face shields, two thermometers, and hand sanitizer were available at the screening table. On 4/18/22 at 11:05 AM, an observation was made of the Maintenance Supervisor (MS). A family member was on the 100 hallway talking to LPN 2, the MS asked a visiting family member of a resident to put a mask on. On 4/18/22 at 11:07 AM, an interview was conducted with the family member (FM). The FM stated she thinks she was supposed to check in when she comes to visit but she did not. The FM stated no one at the facility showed her how to check in and she had not worn a mask when visiting for the 10 days her family member had lived at the facility. On 4/19/22 at 8:15 AM, surveyors entered the facility. The Administrator in Training (AIT) was at the front door. The AIT stated that she did not usually sit at the front entrance because there was usually another staff member that screened visitors and directed them within the facility. The AIT stated that the front entrance staff member recently quit and now the facility was rotating through staff members to sit at the front entrance. The AIT stated the staff members at the front entrance were decided during the morning meeting and she was not sure who covered the front desk when she was not there. The AIT stated she was currently screening people as they came in for COVID-19. The AIT stated there was a visitor screening questionnaire that she filled out when visitors entered and obtained their temperatures. The AIT stated if a visitor answered yes to any question regarding contact or s/sx of COVID-19, then she asked more questions to see where they were at. The AIT stated she would then ask about vaccination status and which resident the visitor was visiting. The AIT stated she understood to not allow a visitor in, if there were any symptoms reported. The AIT stated if a resident had a cough, then she asked more questions. The AIT stated the visitor could also test for COVID-19 at the front entrance. The AIT stated that the name at the bottom of the questionnaire was the person verifying that the screening was done and the visitor was not at risk to enter the facility. The AIT stated if the visitor was unvaccinated, they preferred for them to wear a surgical mask. The AIT stated if the visitor was vaccinated they were able to go without a mask. The AIT stated that employee screening was done in a binder next to the visitor screening. The AIT stated that employees obtained their temperature and wrote it on their specific form in the screening binder. The AIT stated if there were any symptoms then the employee reported to their immediate supervisor or Administrator. The AIT stated that COVID-19 testing was available and the staff member would be quarantined until the test was complete. The AIT stated that COVID-19 testing was completed by the nursing office on the other side of the building. The AIT stated she did not know what the L or H meant on the employee specific form. The AIT stated she did not mark the L or H, because she did not know we were supposed to. The AIT stated if the temperature was in the range then the L or H would be marked. On 4/19/22 at 12:06 PM, an interview was conducted with LPN 1. LPN 1 stated visitors were screened at the front entrance for COVID-19. LPN 1 stated a temperature was obtained and the visitor was asked if they had been out of town or feeling sick. LPN 1 stated that the L or H on the employee screening was determined based on an assessment form. LPN 1 located the assessment form next to the employee screening. LPN 1 stated the L and H were for low or high risk based on the assessment. LPN 1 stated if an employee was at high risk to any questions, the employee would step outside for the nurse to assess. LPN 1 stated a rapid COVID-19 test was completed in the managers office. LPN 1 stated that there was usually a staff member at the front desk from about 9:00 AM to 5:00 PM. On 4/19/22 at 12:13 PM, an interview was conducted with the Director of Rehabilitation (DR). The DR stated when he had screened employees, he asked questions, took their temperature, and made sure their mask was on. The DR stated if the employee had a high temperature or they answered yes to any of the questions, the employee went outside and around the building to have a COVID-19 test. The DR stated that for visitors, he took their temperature, had them fill out the questionnaire form, and encouraged them to wear a mask. The DR stated if a visitor had an elevated temperature, he let them know they should not be in facility. The DR stated he encouraged the visitor to get tested for COVID-19 and once they were negative, to come back to the facility. The DR stated that everyone who came into the facility was screened. The DR stated that there was no one at the front desk on weekends. The DR stated the 200 hall charge nurse kept an eye on the door and screened visitors on weekends. The DR stated contracted employees such as hospice staff should know they need to screen like everyone else. On 4/19/22 at 12:26 PM, an interview was conducted with CNA 5. CNA 5 stated when she entered for her shift she had her temperature checked and wrote the temperature on her specific sheet and them marked if she was low or high risk for COVID-19. CNA 5 stated she had COVID-19 in January 2022 and she came to work and marked she was high risk. CNA 5 stated she was tested at the nurses station and waited in the back room for her test results and was sent home. CNA 5 stated when visitors entered the facility, if their temperature was not higher than 98 degrees they were able to come in. CNA 5 stated if the visitors temperature was higher than 98 degrees they would have to wait until symptoms were gone to come back to visit. CNA 5 stated there were no forms that she filled out for visitor screening. CNA 5 stated that she thought there might be a visitors sign in sheet there at the front. On 4/19/22 at 12:38 PM, an interview was conducted with the Activities Director (AD). The AD stated usually when a visitor came in she asked them COVID-19 screening questions that were on the form and obtained their temperature, had them sanitize their hands, and put on a mask. The AD stated visitors usually filled out the form in the visitor bind. The AD stated the employee that obtained the visitors temperature signed the form at the bottom. The AD stated there was an employees screening form and a flow sheet to determine if a staff member was at low or high risk for COVID-19. The AD stated if the employee was high risk, then someone from the nurse management or the charge nurse did an assessment on the employee. On 4/19/22 at 12:38 PM, an interview was conducted with CNA 8. CNA 8 stated staff were screened for COVID-19 before their shift. CNA 8 stated a temperature was taken and recorded in the staff binder. CNA 8 stated the nursing staff would take the staff members temperatures and if they were not available, another CNA did it. CNA 8 stated the staff member reviewed the list of symptoms to determine if they were a low or high risk. CNA 8 stated if staff were high risk, the nurse was informed, and an evaluation was done. CNA 8 stated if the nurse felt a COVID-19 test was needed, they tested the staff member. On 4/19/22 at 12:41 PM, an interview was conducted with the Resident Advocate (RA). The RA stated that there was an employee or charge nurse that screened other employees for COVID-19. The RA stated that the employee took the other employees temperature and asked questions. The RA stated if the employee was at medium to high risk then a nurse manager was contacted. The RA stated that the nurse manager then asked additional questions to see if the employee was safe to come to work. The RA stated that the employee sanitized their hands, a temperature was obtained, and a mask was put on. The RA stated visitors had a different form to complete. The RA stated that visitors filled out a log, obtained temperatures, filled out a form, and the employee at the front entrance screened each visitor. The RA stated the employee made sure the visitor had a mask on, hands sanitized, and their temperature was okay. The RA stated she was at the front entrance most of the time and there was a receptionist. The RA stated the receptionist was at the front entrance from 9:00 AM to 3:00 PM. The RA stated she covered the front desk from 3:00 PM until 5:00 PM. The RA stated that after 5:00 PM until about 9:00 AM the 200 hall nurse was in charge of screening visitors. The RA stated that the CNAs helped notify the nurse if someone was at the front desk. The RA stated that CNAs were able to notify the nurse through an app or a walkie. The RA stated that there were times that CNAs and nurses were busy in resident rooms and she was not there so she did not know how the visitors were stopped and screened at the front entrance. The RA stated visitors during the day were good at stopping and screening themselves and letting someone know they were there. A binder labeled Visitor log was reviewed on 4/19/22. The log revealed a section for date, name, resident visited, time in, and time out. There was a Visitor Screening Questionnaire for COVID-19 forms in the binder. There were no questionnaires completed from 4/4/22 until 4/19/22. A review of the log and questionnaires revealed they did not match. The log did not have any signatures for visitors on 4/17/22. There were no questionnaires completed for visitors on 4/17/22. [Note: The date 4/17/22, was Easter.] On 4/19/22, there were 13 visitor names on the log and there were 6 Visitor Screening Questionnaire forms completed. The Visitor log further revealed that from 3/28/22 through 4/4/22, 30 visitors signed the visitor's log but did not complete a screening questionnaire for visitors, and 27 visitors completed a screening questionnaire for visitors but did not sign the visitor's log. The records showed that one visitor filled out the visitor's log and completed the screening questionnaire for visitors two times for two separate visits. A binder at the front entrance titled Employee screening revealed the following: 1. The MS did not indicate if he was low or high risk on 4/11, 4/12, 4/18 and 4/19. 2. CNA 9 did not indicate if she was low or high risk on 4/12 and 4/14. 3. The Transportation staff member did not indicate if he was low or high risk on 4/11, 4/12, and 4/13. 4. The DR did not indicate if he was low or high risk on 4/8 and 4/14. 5. CNA 2 did not indicate if she was low or high risk on 4/7 and 4/8. 6. The RNC did not indicate if she was low or high risk on 4/12. 7. CNA 6 did not indicate if she was low or high risk on 4/10, 4/11, 4/12, 4/13, 4/16, 4/17, 4/18 and 4/19. 8. Nurse 1 did not indicate if she was low or high risk on 4/1, 4/2, 4/3, 4/8, 4/9, 4/10, 4/15, 4/16 and 4/17. 9. Nurse 2 did not indicate if he was low or high risk on 4/14 and 4/16. 10. The DON did not indicate if she was low or high risk on 4/5, 4/6, 4/7, 4/8, 4/11, 4/12, 4/13, 4/14, 4/15, 4/17, 4/18 and 4/19. 11. CNA 11 indicated she was high risk on 4/13. It should be noted there was no additional information on the form. 12. The Minimum Data Set (MDS) coordinator did not indicate if she was low or high risk on 4/1, 4/4, 4/5, 4/6, 4/8, 4/11, 4/12, 4/13, 4/14, 4/15, 4/18 and 4/19. 13. The Laundry Service worker had a temperature of 99.1 degrees written on 4/13/22 and did not mark if she was high or low risk on 4/16 and 4/19. 14. The CNA Supervisor did not indicate if she was low or high on 4/7, 4/8, 4/9, 4/11, 4/12, 4/13, 4/14 and 4/16. 15. The AIT did not indicate if she was high or low on 4/14, 4/15, 4/19 and 4/20. It should be noted that the binder was reviewed on 4/19. 16. The RA did not have temperatures documented 4/1 though 4/6. On 4/20/22 at 8:30 AM, a telephone interview was conducted with CNA 3. CNA 3 stated he had worked at the facility for a couple of months, night shift on the 100 hallway. CNA 3 stated that when he arrived at his shift, he entered through the front entrance, got a mask, screened in for COVID-19, but had forgot to screen for a little while for the last couple month. CNA 3 stated that to screen he should have filled out a paper, taken his temperature, and checked for symptoms. CNA 3 stated that on 4/16/22, he was only at the facility for about 20 minutes. CNA 3 stated that on 4/16/22, he went in the front entrance, did not screen, went through the 200 hallway to the elevator, tested himself for COVID-19 at the 100 hall nurses station. CNA 3 stated that he had chills, congestion, muscle aches, but no fever. CNA 3 stated he thought he had a cold. CNA 3 stated that while waiting for his COVID-19 test results he filled up a residents mug in room [ROOM NUMBER] and delivered it to him. CNA 3 stated he did not have contact with any other residents. CNA 3 stated that he texted the CNA Supervisor on 4/15/22, and told her he was not feeling well, she told him to come in and get screened by the nurse. CNA 3 stated that he overslept for his shift on 4/15/22, so he did not work. CNA 3 stated that he worked on 4/14/22, and wore a surgical mask with no other PPE. A time sheet was provided which revealed CNA 3 worked 4/12/22, 4/13/22 and 4/14/22. The time sheet revealed CNA 3 worked on 4/16/22 from 10:00 PM until 10:40 PM. There were no temperatures or screening forms completed on those days for CNA 3. On 4/20/22 at 8:50 AM, a phone interview was conducted with the CNA Supervisor. The CNA supervisor stated if a CNA had s/sx of Covid-19, the CNA was to be assessed by a nurse and tested before starting working. The CNA supervisor stated staff members checked in at the front entrance. The CNA supervisor stated CNA 3 texted her that he was not feeling well and called off for a shift on 4/15/22. The CNA supervisor read CNA 3's text on 4/15/22 at 5:00 PM, I wasn't feeling good last night, anyway that I could get tonight off? The CNA supervisor stated her response was I'm sorry you are sick and let the nurse know so they can assess you and if the nurse could give you a Tylenol at 5:05 PM. The CNA supervisor stated she did not ask about any further symptoms. The CNA supervisor stated the process for screening employees was to enter through the front entrance, someone took temperatures, and the employee completed a screening form. The CNA supervisor stated that there was a form with a calendar with 2 months on it and the employee determined if they were low or high risk. The CNA Supervisor stated that low or high risk was determined by if they had been around people with COVID-19 or if there were s/sx of COVID-19 because those would make an employee high risk. The CNA Supervisor stated that she trained CNA's on how to screen in. The CNA supervisor stated that the visitor screening process consisted of checking in at the front entrance, making sure the visitor had a mask, a form with questions about s/sx was completed, and temperature obtained. On 4/20/22 at 1:11 PM, a follow up phone interview was conducted with the CNA Supervisor. The CNA supervisor stated that 2 to 3 times since January 2022 she had been unable to find a nurse to screen her in. The CNA Supervisor stated she thought she had been circling the L on the form and did not know why she had not completed it for dates listed above. On 4/20/22 at 11:33 AM, and interview was conducted with CNA 5. CNA 5 stated she arrived this morning at 6:00 AM, took her own temperature, and wrote it down in the book. CNA 5 stated she then clocked in and put her stuff away on the unit where she would be working. CNA 5 stated that if she had a fever, she would contact the nurse immediately to be tested for COVID-19. CNA 5 stated that when the nurse arrived, she looked at the temperatures recorded in the book and asked the staff if they had any signs or symptoms of COVID-19 or if they had been in contact with anyone who had COVID-19. On 4/20/22 at 10:24 AM, an interview was conducted with the Administrator. The Administrator stated CNA 3 called in sick on 4/15/22, because he was not feeling well. The Administrator stated she received a picture text from CNA 3 at 10:58 PM on 4/16/22, of a positive COVID-19 test. The Administrator stated that she called CNA 3 and sent CNA 3 home. The Administrator stated that CNA 3 told her that he had symptoms when he worked 4/14/22. The Administrator stated that CNA 3 should have been screening in prior to every shift. The Administrator stated not screening in was grounds for a write up. The Administrator stated that everyone was very aware of the process and when to screen prior to their shift. The Administrator stated that the 200 hallway nurse would have screened him and found he was high risk and then the nurse should have talked to the DON or Administrator, then CNA 3 would have been tested prior to working on 4/14/22. The Administrator stated that there were COVID-19 testing supplies at the nurses station. The Administrator stated if a staff became sick on shift they would test for COVID-19 at the nurses station but otherwise the test was done prior to entering the facility. The Administrator stated they completed contract tracing and determined that CNA 3 only exposed 3 resident on 4/14/22, to COVID-19 so those residents were tested on [DATE]. The Administrator stated CNA 3 was the only CNA working on the 100 hallway on 4/14/22. The Administrator stated that CNA 11 was not tested and no s/sx were reported on 4/14/22, when she marked she was high risk. The Administrator stated that if a staff member marked an H then the nurse assessed and reported to the DON or Administrator. The Administrator stated if suspicious of anything, then COVID-19 testing was completed. The Administrator stated that the flow sheet to determine a staff members COVID-19 risk was great but there needed to be further assessment. The Administrator stated if the staff member tested negative, the staff member would still be able to continue their shift. The Administrator stated if a staff member was high risk because of a COVID-19 exposure, then the staff member wore an N95 mask and eye protection. On 4/21/22 at 5:33 AM, a phone interview was conducted with CNA 10. CNA 10 stated she worked the night shift from 6:00 PM to 6:00 AM. CNA 10 stated that she entered through the front entrance, checked her temperature, signed in a book, and got a mask. CNA 10 stated that the sign in was for her temperature and she was not sure what the L or the H were for on the form. CNA 10 stated there had been a few times that she forgot to do her temperature. CNA 10 stated there were no staff members at the front entrance and she was not aware of the process for screening visitors. CNA 10 stated there were a lot of visitors on 4/17/22, because it was Easter and she was not sure if anyone had signed in or screened. A review of CNA 10's time sheet revealed she worked on 4/12/22. There was no temperature documented on her screening form, nor if she was low or high risk. A review of LPN 3's time sheet revealed she worked on 4/12/22 and 4/16/22. There was no temperature documented on her screening form, nor if she was high or low risk for 4/12/22 and 4/16/22. A review of Housekeeping staff member 2's time sheet revealed she worked on 4/4/22. There was no temperature documented on her screening form, nor if she was high or low risk. On 4/19/22 at 1:42 PM, an interview was conducted with the Administrator. The Administrator stated that visitor and employees entered through the front entrance and had COVID-19 screening books at the front entrance. The Administrator stated that each employee had their own page and when an employee came to work they needed to pull another staff member to obtain their temperature, and ask for s/sx. The Administrator stated that employees were assessed as low, medium, or high risk for COVID-19. The Administrator stated if an employee was medium or high risk then a discussion was done with the employee as to why they were high risk for example allergies. The Administrator stated if an employee was a high risk exposure, then the employee did not work. The Administrator stated the L and H on the employee form were following the CDC check list. The Administrator stated each day employees should assess their risk, temperature, and complete the form. The Administrator stated no one audited the employee or visitor forms. The Administrator stated Ideally the floor nurse should be screening the employee and the DON would be auditing to ensure screening was done. The Administrator stated that there was a visitor binder at the front entrance. The Administrator stated there was a questionnaire and a log. The Administrator stated there was an employee at the front entrance but had recently resigned. The Administrator stated if no one was at the front door there were signs and staff members walking around. The Administrator stated if the visitor was high risk, they were asked not enter the facility. The Administrator stated that the AIT and AD had taken over for the employee at the front entrance to screen visitors as of 4/19/22. The Administrator stated that there were not enough staff to be able to man the front entrance 24 hours per day 7 days a week. The Administrator stated that a majority of traffic was during the day and not in the evening. The Administrator stated if a visitor walked in and did not get a staff member they have all the tools to screen themselves. The Administrator stated there was a check in log and visitors completed the screening questionnaire. It should be noted when surveyors entered on 4/18/22, there were no blank logs or questionnaires in the binder at the front entrance. On 4/20/22 at 10:47 AM, an interview was conducted with the RNC and DON. The DON stated for employees the nurse or someone else screened them for COVID-19. The DON stated th[TRUNCATED]