Facility Evaluation Report

Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to conduct a annual visit. LPA was granted entry. LPA introduced themselves and discussed the purpose of visit with Administrator Dung Ho.

During the visit LPA toured the facility. Facility is a 5 bedroom (4 client rooms,1 staff room) 2 bathroom, single story home. Home is a Level 2 Adult Residential Facility. There are 3 Clients in care. LPA observed proper covid signage at front entrance of facility as well as sanitization station upon entrance. Facility has required Department postings. LPA observed Emergency Disaster plan and observed copy of Administrators Certificate expiring 01/5/2023. LPA toured all clients rooms, rooms contained required furniture such as beds, dressers, night stands and lighting. All restrooms observed contained working wash basin, toilet, soap, toilet paper and hand towels. Bathrooms had proper hand washing signs posted. LPA observed an outside visitation area with shading. Clients were observed relaxing in bedrooms. Facility has connected operating smoke detectors. Facility has 4 fire extinguishers mounted and fully charged. Facility has ample emergency food and water supply. Facility has a secured location for sharps. Facility has a secured location for client medication and files. During today's visit LPA reviewed clients medications. Clients have 30 day supply of medications. LPA reviewed 3 clients files. Files reviewed had updated Emergency Contact information and Physician's reports. Facility had ample supply of PPE. Facility has a secured location for toxins and hazardous materials. During visit LPA discussed with Administrator/Licensee the importance of care, supervision of clients and updated medical reports.

No deficiencies noted during todays visit. An exit interview was conducted with Administrator Dung Ho and a copy of this report was left at facility.