Facility Evaluation Report

On 4/4/23 at approximately 10am Licensing Program Analyst (LPA) Maja Jensen arrived at facility announced to conduct a scheduled and required 1 year annual visit. The facility has no clients at this time. LPA Jensen met with Licensee Ryan Chan and explained the purpose of today's visit. Ryan holds current Administrator's certificate # 6047821735 good through 5/3/24.

The facility is licensed for 4 residents, 1 of which may be non-ambulatory. LPA Jensen toured the grounds and interior of the facility. All exterior paths were free of debris. The backyard was observed to have an area that is shaded and had sufficient outdoor patio furniture for resident use. The facility has an ADA accessible ramp at the entrance and a stand with hand sanitizer posted outside of the entrance. The facility has all required postings including but not limited to the latest Provider Information Notices, "See Something, Say Something" Disability Rights, employee rights, Emergency Disaster Plans, infection control mitigation and activities calendar. The Emergency Disaster Plan was reviewed and determined to be in compliance.

The facility was observed to be sanitary and free of odor. LPA Jensen observed sufficient furniture and lighting throughout. The facility maintains an adequate supply of linen and PPE. Sharp objects and toxins were observed to be locked and inaccessible to future residents in care. There is a locked medication cabinet available for use. The facility maintains an first aid kit that was observed to be complete with scissors, tweezers, thermometer, various wound dressings and manual. The carbon monoxide detector was tested and found to be ion good working order. The fire extinguisher was purchased on 4/12/22 and is in compliance. The thermostat was set at 68 degrees and is in compliance. The water temperature in the resident bathrooms was measured an 110.8 and falls within the required regulatory range of 105-120 degrees.