Facility Evaluation Report

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection on May 15, 2023. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that three (3) clients reside at this facility and there are currently one (1) caregiver present. There is no Infection Control Plan on file. Administrator arrived during the inspection.

LPA conducted a tour of the exterior and interior of the facility. The inspection will need to be concluded at another time due to language barrier with Caregiver and Administrator designee in obtaining documents for LPA to complete the inspection process. The following domain was completed: Infection Control. No immediate health and safety risks to residents in care observed.

Client Records-Incident Reports/Clients Rights-Information/Dental- LPA began review of client records. Three (3) 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.

Personnel Records/Training/and Staffing- LPAs began review of employee records- Two (2) records were reviewed. LPA reviewed employee records for first aid certification-no current copies of CPR, criminal record clearance or an exemption, health screening-missing and TB test results, employee rights, training verification-missing, and current administrator certification; expiration date 2/25/2021.

Food Service- Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for chemicals and sharps in the kitchen. Sharps observed stored with cleaning products in locked cabinet, Administrator immediately relocated sharps. (Continued on LIC809C)