Facility Evaluation Report

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

A tour of the physical plant was conducted at 9:13 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 five (5) bedrooms and three (3) bathrooms currently occupying six (6) residents. One (1) bedroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory resident, one of which maybe bedridden on Room #1. Hospice waiver for three (3) 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 75°F. Smoke detectors were tested and observed to be operational. There is a carbon monoxide detector installed in the facility. There is a fire extinguisher located in the living room and was observed to be full and last inspected on 05/18/23. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. The swimming pool is appropriately fenced and observed to be locked. (continued on LIC 9099-C)