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 Administrator Sison Tes and explained the purpose of the visit. There are 4 level 4E ambulatory developmentally disabled clients in the home. The facility is a single story home licensed for 3 ambulatory and 1 non-ambulatory clients located in a residential neighborhood. It consists of 3 resident bedrooms, 1 staff room, 3 bathrooms, dining room, kitchen, living room, family room, outdoor patio, and attached garage. The last fire drill was conducted on 9/1/2021. Administrator certificate expires 10/5/2021.

The interior and exterior physical plant was inspected.

COVID-19 Infection Control Practices and signs were observed in the entrance, common areas, hallways, bathrooms and resident rooms.

Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Furniture was observed to be at least 6 feet apart.

Facility has one (1) designated isolation room.

Three (3) centrally stored resident medication records were reviewed.

Due to client's disability and behaviors none of the clients in care were observed wearing masks.

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

A posted Emergency Disaster Plan was observed.

Sufficient supply of Personal Protective Equipment (PPEs) was observed. .

Staff and resident files were not reviewed during today's visit.

Exit interview was conducted with Administrator Tes Sison. A copy of the report was provided.