Facility Evaluation Report

Licensing Program Analyst (LPA) Tihesha “Lynn” Smith conducted an unannounced annual/infection control visit to this facility at 8:56 am and observed COVID signs on the front door. LPA was greeted by caregiver Tatyana Hakobyan and temperature was taken and recorded in foyer/waiting area. The administrator was called and arrived at 9:28 am. LPA observed that the six (6) residents were at the facility during visit.

LPA conducted a tour of the physical plant at 9:35 am to ensure there are no health and safety hazards and facility staff are following Title 22 Regulations and the following was noted:

The facility had a Mitigation plan and copy received.

Hand washing, coughing etiquette, physical distancing, and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to be with cover.

Facility has four (4) four bedrooms: (3) three shared bedrooms for clients and (1) bedroom designated as employee room. There are two (2) bathrooms: (1) one for clients located in hallway near client’s bedrooms #1 and #2. There is no body water in the facility.

Bedrooms were toured and observed to be clean and properly furnished. Linen storage was also checked and observed to have ample supply of clean linen and towels. LPA observed six (6) Ready America first aid backpacks. One (1) for each client stored in clients’ closet.

Bathrooms were observed to be clean and sanitary with necessary supplies. Hot water temperature range between 105 and 120-degrees Fahrenheit.

Physical plant was checked for cleanliness and condition. Facility was in good repair and observed to be clean and free of clutter during today's visit.

Living and dining room furniture were also checked for functionality (wear and tear). Furniture was observed to (Cont on 809C)