Facility Evaluation Report

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that four (4) clients live at this facility, however there is only one (1) present at the facility during this annual inspection. There was one (1) staff member present. The Administrator, Paulina M Corona conducted the facility tour. There is an Infection Control Plan on file.

Client Records-Incident Reports/Clients Rights-Information/Dental- LPA reviewed client records. Four (4) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed the Administrator accurately count the P&I for four (4) residents.

Personnel Records/Training/and Staffing - LPA reviewed employee records. Ten (10) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Staff 1(S1), Staff 2 (S2), Staff 3 (S3) did not have TB test results on file. Paulina M Corona, Administrator’s license expiration date is 10/31/2023.