Facility Evaluation Report

Licensing Program Analyst (LPA) Gary Tan, met with administrator Tami Akahoshi for a One (1) Year Required Infection control visit for this facility.

A tour of the physical plant was conducted at 1:15 PM and the following were noted:

The main door is the only entrance being utilized for entry. There is a sign on the door that everyone entering at the facility must wear mask and must be screened. Screening area is located around 10' upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened by the staff upon entry. All staff were observed to be wearing mask.

The facility had submitted and approved Mitigation plan.

Signs to wear a mask and other Covid 19 prevention protocol signs were posted on the walls. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to be with cover. The facility has a designated visitors' area at the front and backyard. The facility has sufficient stock of PPE in the storage room.

The facility has seven (7) bedrooms and four (4) bathrooms currently occupying six (6) residents on six (6) private bedrooms. One (1) bedroom and one (1) bathroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents and has hospice waiver for two (2).