Facility Evaluation Report

At 12:55 PM, Licensing Program Analyst (LPA) Melissa Ruiz conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by staff William Tan who granted access to the home. Administrator Clifton Von Buck was contacted by phone. The LPA spoke with the administrator and stated the purpose of the visit. The administrator stated he was out of town and was unable to meet the LPA at the facility. This is an four (4) bedroom, two (2) bathroom single story adult residential care facility. A physical tour was initiated at 1:10 pm and observed the following: Infection control: Some infection control signage was observed outside the home and inside the facility. LPA reminded administrator to include all necessary postings outside. Upon entrance, staff took LPA's temperature and was asked to sign-in the visitor’s log but was not asked any infection control questions. Hand sanitizer was available, and trash cans were observed to have closed tight fitting lids. Sufficient PPE supplies were observed. Food Inspection: LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Sharps, cleaning supplies and medications are centrally stored in locked cabinets in the kitchen area. Smoke detectors/carbon monoxide were located throughout the facility. At 1:15 PM, they were tested and are functional. Facility maintains a comfortable temperature of 71.0 F. Resident room s: There are three (3) bedrooms designated for resident use, one (1) bedroom is designated for live-in staff. All bedrooms are properly furnished, clean, and have appropriate bedding and linens. Bathrooms: The hot water temperature measured at 113.5 F. Towels and washcloths are not shared. Extra towels and linens were readily available. Garage was attached to the home and is used for storage. Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water. No deficiencies cited. A copy of this report was provided. Exit interview conducted.