Facility Evaluation Report

On 11/02/2022 at 12:34 p.m. Licensing Program Analyst (LPA), Evelin Rios, conducted an unannounced Annual Required visit at the facility mentioned above. LPA was greeted by Staff #1(S1) William Tan, who granted access to the facility. LPA informed S1 the purpose of the visit and S1 called Administrator Clifton Von Buck who could not meet us at the facility. Administrator gave S1 permission to sign today's report. At approximately, 12:38 p.m. a physical tour was conducted with S1 and LPA observed the following:

Infection control: LPA reviewed the facility mitigation plan (approved on 02/27/2021) to make sure licensee was following current infection control recommendations. Upon arrival, LPA was screened and asked to sign-in the visitors’ log. In addition, LPA was asked all infection control questions. Proper signs were observed inside along a wall to the kitchen and in the restroom. Hand sanitizer was also observed. S1 stated they have sufficient PPE supplies for clients and staff.

Kitchen: LPA toured the kitchen area and observed enough supplies of staple non-perishable food for 7 days and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to clients. Cleaning products are kept in a locked cabinet under the kitchen sink. Fire extinguisher was observed by the kitchen to be charged and last serviced on March 22, 2022.

Smoke detectors/carbon monoxide . Smoke detectors were located throughout the facility, and at 12:47 p.m. they were tested and observed to be operational. Carbon monoxide detector was observed in the main entry to the kitchen and observed to be functional.

Bedrooms: There are four (4) bedrooms three (3) of which are designated for client use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. One (1) room is for staff.