Facility Evaluation Report

On 05/24/2022 at 12:35 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an Infection Control Inspection. LPA was greeted by a client at the entry and explained the purpose of the visit. Ida Moore, Care Staff, introduced herself. Frederick Williams (ADM) was telephoned by Ida and was given permission to sign the report.

Facility has a COVID-19 mitigation plan on file. LPA requested a staff and resident roster. LPA observed hand sanitizer and COVID-19 signage in the common area. A thermometer, COVID-19 screening questionnaire, masks, gloves and a visitor sign-in log need to be present at the entry. LPA toured the facility including, but not limited to common areas, bathrooms, bedrooms, kitchen, and backyard. LPA observed mask, cough etiquette, social distancing and handwashing signs posted in the common area. ADM to post 20 seconds to handwashing signs and add covered garbage cans to all shared bedrooms #1, #2 and #3. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. Handwashing stations need to be equipped with soap, paper towels and covered garbage cans for the downstairs and upstairs bathrooms. A 30-day supply of PPE should be centrally stored and accessible to all Care Staff. Hot water temperature in the shared residents' bathroom was measured at 110.9 degrees Fahrenheit (F) and the facility's temperature was 74 degrees (F). Fire extinguisher was observed full and last inspected on 02/24/2022. Smoke/Carbon Monoxide detectors were observed operational and first aid kit was not available.

The following forms are to be updated and submitted to CCLD: 05/31/2022

-LIC308 Designation of Administrative Responsibility (Reviewed)

-An updated copy of Administrator Certificate(s)