Facility Evaluation Report

At approximately 12:40PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Administrator, Rodrigue Ndomo. Facility serves Clients with Disabilities and has an approved fire clearance and capacity for 3 Non-Ambulatory clients. Upon arrival, LPA was informed that there were 3 clients in care and 6 staff members on-site.

At approximately 1:00PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 1:30PM, LPA conducted a walk-though of the facility with Administrator. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a 1 story building with 3 Client bedrooms, 2 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins and dangerous items were observed to be stored inaccessible to clients. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for clients. Mattress pads were in place or available for Client use. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit.

Facility's fire extinguishers were last inspected July 2023. Facility's smoke detectors and carbon monoxide detectors were tested and operational. Facility's last Fire Drill was conducted September 2023.

LPA unable to complete Annual visit. Annual Continuation visit to be conducted at a later date.

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.