Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced annual inspection focusing on the Infection Control Domain. LPA was allowed entry into this home by Christina Gonzalez, Direct Support Professional II (DSP II) and discussed the purpose of today's visit. The facility is licensed to serve four (4) non-ambulatory clients ages 18-59. Current client census is (40. At 10:25am, Administrator Kirsten Pour arrived and assisted LPA Pena with the inspection. LPA toured the facility, observed the COVID-19 procedures, reviewed clients' medications and observed food supplies. This single-story home contains four (4) bedrooms, two and a half (2 1/2) bathrooms, a living room, kitchen, dining area, backyard, and attached garage.

The facility had a universal entrance screening area including a thermometer, PPE supplies, screening logs, and sign-in sheet.

COVID-19 signage was placed in several areas of the facility.

Staff wore face masks throughout their shift.

Facility maintained a 30-day supply of PPE stored in the supply closet in the garage.

The laundry room is located in the garage, it is clean and has cleaning supplies inaccessible to residents.

At 10:35am, the kitchen was inspected. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All the appliances are clean and are working properly.

Cleaning solutions and kitchen knives/sharps were locked and inaccessible.

Hot water temperature was measured in the kitchen and (3) bathrooms. Kitchen was measured at 115.3 deg F, bathroom #1 read at 116.1 deg F, bathroom #2 at 114.8 deg F and bathroom #3 at 116.4 deg F which are all within the required 105 - 120 degrees.

Clients' bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, night stand, light, chair and sufficient closet space.