Facility Evaluation Report

Licensing Program Analyst (LPA) Abeye Duguma met with the Constancia Bugay for a One (1) Year Required - Infection Control visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 2:30pm and the following was noted:

There is one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, infrared thermometer, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing masks upon entrance and during the visit. Signs to wear masks 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 outdoor visitors' area located in the backyard. The facility has sufficient stock of PPE in a storage cabinet located in a kitchen cabinet. The facility has a total of six (06) bedrooms of which four (04) are for residents and three (03) bathrooms of which two (02) are for residents. The facility is fire cleared for six (06) ambulatory residents. The facility is currently occupying zero (00) ambulatory residents. The facility does not have a swimming pool/body of water. The garage is being used for storage and parking. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry room. Food Service/Kitchen area was sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests.

Knives and sharps are observed to be locked in a kitchen drawer inaccessible to residents. Living/common and dining room furniture were also checked. The living/common room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 70°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguishers are located in the kitchen area, observed to be full and last inspected on 11/02/2021. Staff room was observed to be locked and located upstairs. No medications are observed in the staff room. The residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 119.3°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinet near the front entrance and upstairs. LPA observed medication and first-aid kit to be locked and inaccessible to residents in the kitchen.

Exit interview conducted. Copy of this report issued.