Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with staff Flordeliza Rosana and explained the purpose of the visit. There are five (5) ambulatory mentally disabled clients ages 59 and under. Facility is a single story home located in a residential area consisting of 3 client bedrooms, 1 staff room, 2 bathrooms, kitchen/dining area, living room, attached garage with laundry area, and covered patio area. The last fire drill was completed on 4/23/22. Administrator certificate expires 3/26/2023.

COVID-19 Infection Control Practices were observed upon entry and in common areas.

Infection control signs, and other signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. PPEs were observed.

Facility does not have designated isolation room/area; protocol is to contact DMH and DPH.

All bedrooms and common areas have hand sanitizer. Residents are provided masks.

Five (5) centrally stored resident medication records were reviewed.

Staff responsible for direct care and supervision was observed wearing a mask.

Clients were not observed wearing masks in the home.

Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.

A Emergency Disaster Plan was not posted but provided upon request.

Light bulbs in both bathrooms are needed. A cover for the f luorescent light bulbs shall be installed.

The carbon monoxide detector on the wall was not operable. However, there was a brand new carbon monoxide detector with batteries that has not been installed. Smoke detector in room #1 needs batteries. A new smoke detector was observed, but needs to be installed. Technical Violation was issued.

Exit interview was conducted with staff Flordeliza Rosana. A copy of the report and appeal rights were issued.