Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen made an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee/Administrator Jeff Jackson and House Manager Jose Gabriel “Gabby” Salom.

According to the facility’s license, the facility has a maximum capacity for four (4) clients, of whom all must be ambulatory. Per LPA observation, LIC602 Physician’s Reports, and staff interviews: During today’s inspection, there were a total of four (4) clients in care, and all were ambulatory.

LPA interviewed multiple clients and staff. LPA also reviewed the administrative and training records all personnel. LPA, accompanied by Licensee’s staff, also toured the interior and exterior of the facility, and inspected all common areas and client bedrooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens, hygiene, and Personal Protective Equipment (PPE) supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.