Facility Evaluation Report

Licensing Program Analysts (LPAs) Luis Mora and Erik Zaragoza conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Gislene Petnga Djiki (administrator) and explained the reason for the visit. Physical Plant was toured, client files and medication records were reviewed, staff files were reviewed and food supply was inspected.

LPAs and Administrator toured the home and inspected 2 client bedrooms, 1 staff office, 2 client and 1 staff bathroom, kitchen, dining area, living room, laundry room, front yard, backyard, and attached garage. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the clients located in the backyard. Passageways and exits are free of obstruction. The water temperature was tested in all bathrooms and all measured at 105 degrees F which is not within the required 105 - 120 degrees. Client bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Client beds have the required linen and the linen is in good condition. There is a cabinet in the laundry room with extra clean linen and towels. Smoke detectors combined with carbon monoxides were observed in each room and throughout the facility, and are properly operating. There is one fire extinguisher located in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sufficient supply of 2 days perishable & 7 days non-perishable foods were observed in the kitchen. Sharps are locked in a cabinet in the staff office and are inaccessible to clients. Cleaning supplies and toxins are locked in a cabinet in the laundry room and under the kitchen sink, and are inaccessible to clients. First Aid kit was fully stocked with current manual and it is kept locked in the medication cabinet in the staff office. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. A supply of 30 day Personal Protective Equipment (PPE) was observed in the staff office. Client medications and files are centrally stored in a locked cabinet in the staff office. Staff files are kept locked in a file cabinet in the staff office. All four of the client files and medications were reviewed and no deficiencies were found. Medications are documented properly and given as prescribed. (Continued to LIC 809C)