Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection with the focus of the infection control domain. LPA arrived unannounced and met with Staff, Joe Bondoc. The purpose of the visit was explained. The facility is licensed for 4 ambulatory adults, ages 18 through 59.

LPA toured the facility and observed the following:

* The one story home consists of 4 bedrooms, 2 bathrooms, office room, dining room, living room, kitchen, and an attached garage. There are no pool or bodies of water at the premises.

* Covid-19 signage are posted at the main entrance and throughout the facility. Hand washing signs are posted in the bathrooms.

* The clients have their own private room and can quarantine in their own room.

* A PPE station is set up by the main door and extra PPE supplies of at least 30 days are observed.

* Food supplies of 2 day perishable and a week of non-perishable are observed.

* Medications are centrally stored in locked cabinet. All 4 clients' medications were reviewed and no discrepancies were found.

* All 4 clients' file have updated emergency contact information. Emergency numbers for agencies are also posted on the wall for staff use.

* Staff were observed wearing a face mask.

* Staff are cleaning daily and more often if needed.

* Cleaning solutions are locked under the kitchen sink. Knives and sharps are also locked away in a kitchen drawer.

* LPA interviewed 2 Staff and a client on the visit today.

There are no deficiencies issued today. The exit interview was held. A copy of this report was given to the Staff Bondoc.