Facility Evaluation Report

Licensing Program Analyst (LPA) Tihesha “Lynn” Smith conducted an unannounced annual/infection control visit to this facility at 9:00 am and observed COVID signs on the front door. LPA was greeted by caregiver Pierrot Ntoya and temperature taken upon entry. LPA was given sign in log to record temperature and answer Covid follow-up questions printed on sign in log sheet. The administrator was called and arrived at 9:30 am.

LPA conducted a tour of the physical plant at 10:25 am to ensure there are no health and safety hazards and facility staff are following Title 22 Regulations and the following was noted:

The facility had a Mitigation plan and copy received.

Hand washing, coughing etiquette, physical distancing, and other necessary signs were posted in the bathroom and all over the facility.

The facility has four (4) bedrooms: three (3) bedrooms for clients and one (1) bedroom designated as staff room/office. There is a half bathroom (toilet/sink) in bedroom #3 and (2) two bathrooms: one (1) near bedrooms #1 and # 2 and one (1) bathroom in staff room/office. There is no body water in the facility.

Bedrooms All bathrooms were clean, properly supplied and had functional fixtures. Linen storage was also checked and observed to have sufficient supply of clean linen.

Bathrooms were observed to be clean and sanitary with sufficient supplies. Hot water temperature range between 105 and 120-degrees Fahrenheit.

Physical plant was checked for cleanliness and condition. Facility was in good repair and observed to be clean on today’s visit.

Living and dining room combo was observed to be clean and furniture in good condition and adequate seating for clients. LPA observed an adequate supply of PPEs store in closet to left of front door and a small (Cont to 809C)