Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with Administrator Tega Ugbeyiae who allowed the entry of the facility and assisted with the visit. The purpose for the visit was explained. The facility is licensed to serve four (4) ambulatory clients ages 18-59.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and here are the domains that LPA inspected:

1, Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting the clients. Staff are cleaning and disinfecting at least once or twice for high touched surface area. Facility has sufficient PPE supplies and has an Infection Control Plan.

2. Physical Plant and Environmental: The facility is a single story house and located around the residential neighborhood area. The facility includes: living room, four clients bedrooms, two bathrooms, staff office, dining area, kitchen and detached garage. LPA inspected the carbon monoxide detectors and its mounted on the wall near the kitchen care. The smoke detectors are located in each bedroom and common area and they are all interconnected and working properly. LPA tested the hot water in two bathrooms and they are tested between 108.5 and 109.5 degrees F and its within the Title 22 regulation. All the sharp knives and utensils are locked in the file cabinet next to the kitchen. All the chemicals and cleaning supplies are locked in the hallway cabinet. The facility has ample personal hygiene products for clients. All the clients rooms are clean and furnished and have required beddings.

3. Operational Requirements: The facility maintained a fire clearance approved by the fire department which four ambulatory client and currently all clients in the facility are ambulatory. The facility also has shaded area with table and chairs for client to utilize for outdoor activity. The last fire/disaster drill were conducted on 3/11/23.