Facility Evaluation Report

On December 8, 2021, at 11am, Licensing Program Analyst (LPA) DeAnna Williams-Lyons , arrived unannounced to conduct a 1 year required Annual Visit. LPA met with Destiny Bagsby, Site Manager and informed her the reason for the visit.

Prior to the visit, LPA completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19, contacted licensee and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Mask.

Program Director Michael Palmer arrived shortly after. This facility has a fire clearance for 30 non-ambulatory clients. The facility stores medication and files. The facility consists of a kitchen area, class room and activity areas, restrooms and a quiet room. The clients are fully vaccinated and has not had Covid-19.

Destiny and LPA completed the inspection tool questionnaire with no issues or advisories to report. LPA reviewed 7 files with no issues or concerns. All documents were updated and signed.

No citations were issued Per Title 22 Regulations.

Program Director shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file in our Regional Office. Administrator shall submit the listed documents to Licensing later than January 8, 2022.

An exit interview was conducted and a copy of this report was given Michael Palmer.