Facility Evaluation Report

Licensing Program Analyst (LPA) Bruce Jacobs arrived to conduct an unannounced Annual inspection on this date. The Administrators for the facility, Cindy Medina, was informed of the purpose of the visit and was able to assist with the completion of the inspection focusing on the facility's mitigation plan and infection control procedures. The facility has submitted a program design to the Regional Center and is in the process of being vendorized for a VMRC home. The facility will submit the approved program design to Licensing. There are currently no clients placed in the home.

LPA toured the facility and reviewed the Mitigation Plan. LPA previously discussed Personnel Policies, Abuse Reporting Procedures, In-Service Training and Medication Procedures. Smoke alarms were tested and were operable. Fire extinguisher are in compliance and were serviced in June 2021. Facility has working carbon monoxide detectors. There are 3 client bedrooms and 1 1/2 client bathrooms, all in compliance.

LPA observed the following posted in the facility: See Something Say Something complaint poster, Reporting Requirements, Resident Personal Rights, Evacuation Routes and facility license were all posted as required. LIC 500, LIC 308, and LIC 309 were requested to be submitted to Licensing within 30 days as needed.

Exit interview held with acting Administrator and a copy of report given at the conclusion of the visit.