Facility Evaluation Report

On 07/17/2023 Licensing Program Analyst (LPA) David España conducted an unannounced required Annual visit. Upon arrival at the facility, LPA España conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19. LPA met with staff, Dr. Sharouz Ghodsian, Program Director and toured the inside and outside grounds of the facility.

The facility 4-bedroom, 4-bath, single story with full basement, social rehab facility that is licensed for 6 ambulatory adults. During the tour, LPA observed the facility’s infection control practices and sufficient food supplies were observed. LPA observed required posting throughout the facility. Bathroom in basement was checked, sufficient liquid soap and paper towels were observed. Water in basement bathroom tested within range. Toilets and water faucets worked properly. The water temperature measured at restroom was between 105F and 120 degrees Fahrenheit. A comfortable temperature was maintained throughout the facility.

LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food, all not dated. Knives and other sharps were observed accessible to clients in care. First Aid kit was observed in the facility. Fire extinguishers were observed throughout the facility, with all being current. Outside grounds were toured, LPA España observed a pool on site with the gate secured. Walkways around the facility were clear of hazards. Common areas were clean and clear of hazards; doorways were free of obstructions.

Client Records - Incident Reports - Type B: 81069(f)(1) - LPA España and Dr. Sharouz Ghodsian, Program Director observed that Residents 1, 2, 3, 4, and 5 are missing LIC613C and TB.

Disaster Preparedness - Type B: 1565(a) - LPA España and Dr. Sharouz Ghodsian, Program Director observed no plan approved at facility at the time of visit.