Facility Evaluation Report

On 01/19/23, at 1:30 pm, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with Dontri Sangchampa, staff, and the purpose of today’s visit was explained. The facility is licensed to serve (4) Developmentally Disabled Adults ages 18 – 59 (4) non-ambulatories, and (1) approved hospice waiver. The facilities annual fees are due on 1/31/2023, and the current balance is $454.00.

As part of the inspection, my primary focus was on infection control. LPA observed the facility’s infection control practices: LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff and residents, and additional supplies are stored. Sufficient paper, cleaning, and disinfecting supplies were also observed. The facility has the mandated COVID infection control posters. My temperature was taken at the entrance of the facility where there is a sanitizing station and a logbook for visitors to check in.

Currently, the home has (2) ambulatory and (2) non-ambulatory clients. LPA Scott inspected the inside/outside facility grounds. The last fire drill was conducted on 9/06/22. LPA observed that all medications and records are maintained in compliance with label instructions and are inaccessible to the clients. The facility consists of (3) client bedrooms (1) client bathroom and (1) staff bathroom, living room, kitchen, dining area, office, patio, garage used for storage and laundry area. Facility maintains all required posting throughout the facility.