As with all facilities, IDPH provided guidance, recommendations, infection control technical assistance, testing, and other support. On March 4, 2020, Federal CMS issued a memo to state survey agency directors on suspension of survey activities. IDPH began making daily calls to facilities to check on infection control practices, cases, PPE, isolation/quarantine, and other needed support. One such call was made to Niles Nursing and Rehab on May 4, 2020. A surveyor created a survey in the electronic system to document the call, but IDPH learned that Federal CMS wanted only on-site surveys entered. Federal CMS conducted an independent survey on April 22, 2020 and cited the facility with an Immediate Jeopardy. IDPH staff does not accompany federal CMS surveyors on independent surveys. Federal CMS looks at compliance and provides information to the state. Federal CMS indicated the immediacy of the jeopardy was removed on April 23, 2020, however the noncompliance had not yet been resolved.. IDPH continued to make calls to long-term care facilities and work with facilities and the local health departments to provide infection prevention and control support. IDPH also deployed a team to provide infection control guidance and testing at Niles on May 23, 2020. On July 7, 2020 (not June), IDPH conducted a survey and found Niles Nursing and Rehab to be in compliance with state and federal Infection Control requirements. IDPH recognized ongoing infections and sent a surveyor back to the facility on July 28, 2020 and subsequently cited the facility for infection control deficiencies. After the on-site survey, a follow-up was conducted via a desk survey with CMS’ approval. The desk survey requires the facility to submit documents as evidence that it has implemented its Plan of Correction, which can include in-service training logs, newly created or adopted procedures, additional staff education materials, and other remedies. IDPH and CMS continue to try to minimize surveyors’ on-site inspections of long-term care facilities to reduce potential introduction of the virus.