Facility Evaluation Report

An unannounced Required One (1) year visit was conducted on this day by Licensing Program Analyst (LPA) Gary Tan. LPA initially met with staff Dominga Reynante who called the administrator Alexis Nixon. Purpose of the visit is stated. LPA observed that only two (2) client was present at the facility resting in their own bedroom, One (1) client is at work and the other with family for the weekend.

LPA conducted physical plant tour inside and out at 10:30 AM. During the tour, LPA observed that the facility has five (5) bedrooms and three (3) bathrooms. One (1) bedroom and one (1) bathroom is designated for staff use. There is no body of water in the facility.

The front main door is the only entrance being utilized at the facility. There is a sign on the front door that everyone entering at the facility must be screened. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available.

The facility had submitted and approved Mitigation and Infection Plan.

Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to be with cover.

The facility has a designated visitors' area at the front yard. The facility has sufficient stock of PPE in the storage

Bedrooms were toured and observed to be clean and appropriately furnished.

Bathrooms were observed to be clean, sanitary and with necessary supplies. Hot water temperature measured at a range of 106. 8°F to 109. 0°F .