Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met with administrator Agaiotupu Pouesi (Nai) and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, observed food supply, and reviewed clients files. Facility has submitted a mitigation plan and was approved on 06/25/2021.

The facility is a single story house and located up on the hill. The facility included living room, dining area, kitchen, four client bedrooms, two client bathrooms, laundry room, chemical supplies room, storage room, staff office and a detached garage. All four clients bedrooms were toured. Each bedroom has smoke detector, one bed, one drawer, night stand and required linen and sufficient lighting and closet space. All two clients bathrooms were toured and they are clean and sanitary. The hot water in two clients bathrooms was measured between 115.6 and 117.6 degrees F which is within the Title 22 regulation. The refrigerator in the kitchen and the kitchen cabinet is sufficient for two days perishable and seven days non-perishable food supply. All the appliances are clean and working properly. The common areas such as living room and dining area are clean and have the required furniture. The back yard and front yard are maintained well. The back yard has a shaded area with table and chairs for clients to utilize. All the exit and passage ways are free of obstruction. All the cleaning supplies are locked in the chemical supplies rooms and all the sharp knives and utensils are locked in the staff office and under the sink. The clients medication are centrally stored and locked in the top cabinet in the staff office. LPA also inspected the smoke detectors and carbon monoxide detectors in the facility are working properly. All clients' emergency contact information are up-to-dated.

Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, disinfecting products are available in the common area and facility is disinfected every shift, clients bathrooms have sufficient soap, paper towels, and signs and PPE supplies are stored for 30 days.

No deficiencies were found during this visit. Exit interview was conducted with administrator Agaiotupu Pouesi (Nai) and a copy of this report was provided.