Facility Evaluation Report

On 09/30/2021 at 8:40am, Licensing Program Analyst (LPA) T. White spoke with Administrator, Sherri Rossell-Jensen regarding facility risk assessment questions. Administrator confirmed no staff or clients have experienced symptoms within the last 10 days. At 9:35 am, LPA T. White arrived unannounced to conduct a required 1-year Annual inspection. LPA met with Administrator and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 ambulatory clients.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 71 degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 109.4 degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. There is a minimum of 7-day nonperishables and 2-day perishable foods.

Smoke detectors and carbon monoxide were in operating condition during inspection. Fire extinguisher was last serviced on June 02, 2021. Emergency Disaster Plan was last posted on 09/02/2021. Mitigation Plan observed to be complete. First aid kit was observed to be complete. Fire drill was last conducted on 09/01/2021.

The following forms to be updated and submitted to CCLD by 10/08/2021 :

LIC 308 Designation of Administrative Responsibility

LIC 400 Affidavit Regarding Client/Resident Cash Resources

No deficiencies cited during inspection. Exit interview conducted with Administrator and a copy of report given.