Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted an annual inspection with the focus of the Infection Control domain. LPA arrived unannounced and explained the purpose of the visit to the staff who allowed entry. The facility Administrator, Mohammed Shirazi, arrived shortly thereafter.

The facility is licensed for four (4) Non-Ambulatory Developmentally Disabled adults from 18-59 years old.

LPA Chan toured the facility with Staff and observed/inspected the following:

* Temperature is taken prior to entry and an area is set up by the entrance to screen visitors for Covid-19 (Coronavirus) symptom screening.

* Proper signage are posted in the facility and in the bathrooms to promote hand washing.

* There are a total of 5 bedrooms; 4 for clients and 1 for Staff. Client bedrooms all have the required furniture and lighting. There are 2 bathrooms at the facility.

* There is a functional smoke detector in every room and one carbon monoxide detector in the house.

* The hot water temperature was measured within the range of 105-120 degree F.

* Disinfectants are stored and locked in the laundry room, located in the backyard. Knives are stored and locked in the kitchen cabinet.

* Sufficient food supply of 2-day perishable and a week of nonperishable were observed.

* There are no bodies of water or pool at the facility. No items obstructing the walkways.

* Medications were reviewed for all 4 clients and are given as prescribed.

There are no deficiencies observed during the visit. An exit interview was conducted. A copy of this report along with the appeal rights were provided to the Administrator.