Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection with the focus of the Infection Control domain. LPA met with the Administrator, Evelyn Brindis, who assisted with the inspection. The purpose of the visit was explained. The facility is licensed to serve 1 non-ambulatory and/or 5 bedridden adults with a capacity of 6.

LPA toured the facility with the Administrator and observed the following:

* The facility has 5 bedrooms, 2 bathrooms with toilet and sink, living room, dining room, kitchen, and 1 larger bathroom that consists of 2 shower stalls, toilet, and laundry area. The clients' rooms have the required furniture. 4 out of the 5 bedrooms have exit doors with alert system. The facility is well maintained with no items obstructing the passageways. LPA observed signage throughout the facility and in the restrooms for hand washing hygiene. LPA recommended to add additional signage such as sneeze/cough etiquette at the home. PPE supplies for at least 30 days are observed. Food supplies for 2 day perishable and a week of non-perishable are also observed. Knives, cleaning solutions, and disinfectants are stored and locked making them inaccessible to clients. Smoke and carbon monoxide combination detectors are located throughout the facility and operable. The fire extinguishers were last inspected on 5/18/2021. The medications are centrally stored and locked. LPA reviewed 5 clients' medications and staff are administering them as prescribed.

LPA provided a technical advisory for the N95 Fit Testing.

No deficiencies were observed during the visit today. An exit interview was conducted and a copy of this report along with appeal rights were given to Staff.