Facility Evaluation Report

Licensing Program Analyst (LPA) Gary Tan, met with Administrator Mubeen Namuddin for a One (1) year required visit for this facility.

A tour of the physical plant was conducted at 9:23 AM and the following was noted:

There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room.

The facility has six (6) bedrooms and three (3) bathrooms currently occupying five (5) residents. One (1) bedroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory resident, all of which maybe bedridden. Hospice waiver for six (6) residents.

Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings and doors were checked, the following was noted:

Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 74°F. Dual smoke and carbon monoxide detectors were tested and observed to be operational. There is a fire extinguisher located in the kitchen and was observed to be full and last inspected on 09/20/23. The facility is equipped with fire sprinkler system. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. (continued on LIC 9099-C)