Facility Evaluation Report

On 12/07/2022 at 11:06 a.m., Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Required Annual/ Infection Control inspection at the facility mentioned above. LPA was greeted by Administrator Yayineabeba Assefa who granted access. Administrator Yayineabeba took LPA's temperature. LPA explained the reason for the visit. LPA reviewed the Mitigation Plan approved 04/10/2021. The inspection tool was used to complete the visit.

A physical tour was conducted at 11:07 a.m. and LPA observed the following:

Infection control: Proper infection control sign was observed on the outside front door of the facility. Upon entrance, LPA observed, proper infection control signs, hand sanitizer and masks were available. Administrator requested LPA to wash their hands or use hand sanitizer upon entrance. Administrator states the facility has enough PPE for 30 days. The fire extinguisher was observed by the front door and with a purchased date of on 11/09/2022.

Common Areas: These include the dining areas, and two (2) living rooms. All common areas were observed well lit, clean and clear of clutter. Furniture appeared clean and in good repair. There is a fire place in one (1) of the living rooms but is not in use. LPA observed the thermostat at a comfortable temperature of 74°F.

Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Knives are kept locked in a kitchen drawer inaccessible to residents. LPA observed there to be sufficient stock of 7-day non-perishable foods and 2-day perishable foods. A 2nd fire extinguisher was observed by the back patio sliding door and with a purchased date of on 11/09/2022.

Bedrooms: There are four (4) bedrooms designated for resident use. Two (2) out of the four (4) rooms are currently vacant. One (1) out of four (4) is a shared bedroom with only one occupant. All resident rooms are furnished with required lighting, dresser, chair, bed, and linens.