Facility Evaluation Report

Licensing Program Analyst (LPA) Shira Stamps arrived at the facility for an unannounced one (1) year Required visit. LPA arrived at 10:00 am, and was greeted by Licensee Josephine, LPA informed the Licensee of the purpose of the visit. LPA observed two residents watching TV the living room.

A tour of the physical plant was conducted with the Licensee at 10:10 am. The facility has four (4) bedrooms and two (2) bathrooms currently occupying three (3) residents. One (1) bedroom is designated for staff use only. The facility is Fire Cleared for three (3) non-ambulatory, one bedridden, and a hospice wavier for one. The facility currently has one (1) ambulatory and two (2) non- ambulatory residents.

Infection control: LPA reviewed the mitigation plan approved on 3/20/21. The Licensee emailed the infection control plan on 6/16/22. The LPA still needs to review for approval. The facility is following current infection control recommendations. Upon arrival LPA was screened by the Licensee and asked all infection control questions. LPA was asked to sign-in and sanitize hands.

LPA conducted a tour of the kitchen around 10:10 am and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas care clean and inaccessible to pests. LPA observed all knives and sharp object being locked and inaccessible to residents in care. The medication cabinet was also observed to be locked. Cleaning supplies and chemicals were observed to be locked under the kitchen sink.