Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection with the focus of the infection control domain. LPA arrived unannounced and met with Asfunso Elam, the house manager. The purpose of the visit was explained. The facility is licensed for four (4) Developmentally Disabled Adults, ages 18 to 59. Two (2) of the four (4) may be non-ambulatory.

LPA toured the facility with the house manager and observed the following:

* The facility is a one story house with 3 bedrooms, 2 bathrooms, living room, dining room, kitchen, family room, and an attached garage. The first bedroom by the entrance is temporarily designated as the isolation room. The other 2 rooms are currently occupied as shared rooms with 2 clients in each. The first bathroom is utilized by staff only. The other bathroom is for client use.

* LPA observed signage throughout the facility and in the restrooms for hand washing hygiene.

* Temperature are taken for staff, clients, and visitors and are documented daily.

* PPE supplies for at least 30 days are observed.

* Food supplies for 2 day perishable and a week of non-perishable observed.

* Knives, cleaning solutions, and disinfectants are stored and locked in the laundry area.

* Smoke/carbon monoxide detector tested and operable.

* The hot water temperature was measured between the required range of 105 - 120 degree F.

* Medications were reviewed for all 4 clients and medications are being given as prescribed.

No deficiency was observed during the visit today. An exit interview was conducted. A copy of this report and appeal rights were given to the house manager.