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 lead staff who assisted with the inspection. The purpose of the visit was explained. The facility is licensed for four (4) ambulatory adults, ages 18 to 59, of which 1 may be non-ambulatory.

LPA toured the facility with the lead staff and observed the following:

* The facility is a one story house with 4 bedrooms, 2 bathrooms, living room, dining room, kitchen, family room, laundry area, and a garage. The backyard has a shaded area with table and chairs. The clients' rooms have the required furniture.

* 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.

* Facility has a screening area for sign in logs and documenting temperature.

* 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 making them inaccessible to clients.

* Smoke/carbon monoxide detector tested and operable.

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

* Medications were reviewed for both clients and are being given as prescribed.

There was no deficiency observed during the visit today. An exit interview was conducted. A copy of this report and appeal rights were given to the Staff.