Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted an annual required visit. LPA met with Administrator Gary Smalley and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed clients' medications, observed food supply, and reviewed client and staff files.

Facility is a single story house and located in a residential neighborhood. Facility includes living room, formal living room, client bathroom, three clients bedrooms, kitchen, dining area, staff bathroom, two live in staff bedrooms and a attached garage. Each clients bedrooms have two beds, two chairs, two night stands, required bed linen and furniture and sufficient lighting and closet space. LPA observed in Bedroom#1 and the door was broken. The bathroom was toured and its clean, sanitary and in a good working condition. The hot water tested in the client bathroom was measured at 113.9 degrees F which is within the Title 22 regulation. The refrigerator in the kitchen and kitchen cabinet and the garage has sufficient two days perishable and seven days non perishable food. The knives and all the sharp utensils are stored in the lock box in the kitchen cabinet. All the appliances in the kitchen are working properly. The common area such as living room and dining area are clean and have required furniture. The back yard has a shaded area with tables and chairs for clients to utilized. LPA also inspected the smoke detectors and carbon monoxides and they are all working properly.

LPA reviewed all 5 clients' files to confirm emergency contact is updated. LPA also reviewed 4 staff files to confirm health screenings and fingerprint clearances and they are all updated in their personnel file. LPA inspected 5 clients medication and their MARs and they are all seemed updated and accurate.