Facility Evaluation Report

On 08/17/2022, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced follow up inspection to the above facility for the purpose of plan of correction visit for deficiencies issued during the 2022 annual visit on 08/16/2022. LPA met with caregiver Katherine Tavai and explained the purpose of today’s visit. The facility is licensed to operate for four (4) ambulatory developmentally disabled adults of between the ages of 18 through 59.

LPA observed the following on 08/17/2022:

1. Water temperature for all bathrooms sinks and kitchen sink measured between 113.2 F to 116.3 F.

2. Cabinet door under the shared bathroom sink was fixed and working properly

3. Light fixture in room #4 was fixed and working properly

4. Administrator certificate was posted and is current

5. See something, say something poster is posted in the facility

6. Lime around the sink in bathroom for room #4 was cleaned.

There are no further deficiencies to be corrected for the 2022 annual conducted on 08/16/2022. Licensee will receive deficiency cleared letters in the mail.

Exit interview conducted with caregiver Katherine Tavai and a copy of this report was provided.