Facility Evaluation Report

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Annual/Random visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met with Licensee/Administrator Ana Ramos and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved Mitigation Plan Report and Infection Control Report. There is currently one (1), resident in placement. The facility's annual fees are current.

The following Domains will be observed and reviewed: Infection Control, Operational Requirements, Physical Plant and Environmental Safety, Staffing, Personnel Records-Staff Training, Residents Records-Incident Reports, Resident Rights-Information, Planned Activities, Food Service, Incidental Medical and Dental, Disaster Preparedness, and Resident with Special Health Needs,. "LPA Bunker will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services facility inspections.

The facility is a single-family home located in a residential neighborhood. Licensee/Administrator Ana Ramos and LPA Bunker toured the facility which consisted of the following: Living room, dining room, 2 kitchens, 5 bedrooms, 4 bathrooms, office area, laundry room, den/family room, shaded area, indoor/outdoor activity areas, and a detached garage. The front and back yard landscape is in good condition at the time of the visit.