Facility Evaluation Report

Licensing Program Analyst (LPA) Hansen conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and was greeted by Staff Cheryl “Cher” Evans. Staff called Administrator Michael Sus who arrived later. Facility has 5 clients at the moment, 2 were attending day programs during the visit. Three of facilities clients are back to attending day programs. Facility has outings for clients to parks, rivers and other activities during the day.

LPA arrived at the facility and her temperature checked and logged by staff Cher. All staff are temperature checked and logged each shift and wear masks. During facility tour on 6/14/2022 at 9:30 AM with staff Cher and then Administrator Michael Evans, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Client’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 12/29/2021 at the time of the visit. Smoke Detectors & Carbon monoxide detectors were found to be operational during the visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Extra food in the back-spare building refrigerator is properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked closet in the office, behind locked door at the top of basement, in locked kitchen closet, and in locked spare backyard building. Medications are stored in locked cabinet in office. Facility has a 30-day supply of medication for clients There was a supply of cleaners, hygiene product, and paper products available for clients. All client’s bedrooms have lighting & appropriate furnishings. Hot water temperatures measured within acceptable regulations of 105 to 120 degrees F from client’s bathroom faucets. Disaster drills are conducted monthly with the last one being 2-24-2022.

Facility has submitted a mitigation program plan that has been approved. Posters have been placed throughout the facility. Entrance has small table with hand sanitizer and other items designated for visitors and staff before coming into work, logbook is kept in the office. Facility has PPE supply stored in outside shed and office. Facility has not hired or admitted any new clients since the start of the pandemic. Clients do not wear masks inside the facility, however; staff stated that they are able to wear masks when going on outings. All staff had masks on during this visit.