Facility Evaluation Report

Licensing Program Analyst (LPA) Fernandes-Goes conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility was welcome by staff Willie Hogan. Staff contacted administrator Jim Martin. Clients were present during the visit. There is virtual day program at this time due to short staffing at ADP (Adult Day Program). There are activities planned for clients during the day if they want to participate and outings.

LPA arrived at the facility and observed a check in for staff and visitor’s by front door. During facility tour on 8/15/2022 with staff Willie, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Sample of client’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 08/2021 at the time of the visit. Carbon monoxide detector and sample smoke detectors test was conducted and were operational during this visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored locked in the garage and under kitchen sink. LPA observed that dangerous items were locked. There was a supply of cleaners, hygiene products and paper products available for clients. Sample of client’s bedrooms were inspected and had lighting & appropriate furnishings; mattress pads are available for clients at the facility. Facility hot water temperature in clients' bathroom faucet measured between 108.6 degrees F and 108.8 degrees F in 2 out of 2 faucets within Title 22 acceptable regulations of 105 to 120 degrees F. Disaster Drills have been conducted every six months and last dated 6/22/22.