Facility Evaluation Report

On 2-1-23 at 10:23am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a quarterly health and safety check. LPA met with Administrator Adetayo Kokumo and explained the purpose of the visit. Health and Safety check is conducted based on a previous informal conference held originally on 10-27-22.

LPA Bilger inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is a 6-bed residential facility for the elderly with a current census of 3. LPA was screened upon entry for temperature and asked to sign in. COVID screening questions were asked prior to entry. Facility has 6 bedrooms and 3 bathrooms. There is a formal living room and family/TV room for residents. All knives, toxins, and other chemicals were inaccessible to residents in care. Resident rights posted. No obstructions to emergency exits noted.

The facility has submitted a COVID mitigation plan. The facility has central entry point and has implemented screening and sign in procedures at the front door area. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and back yard. The facility has a designated infection control lead. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. LPA observed all staff to be wearing masks during visit. LPA observed facility to be clean and sanitary with no foul odors. There were 2 staff on duty during LPA's visit today. Water temperature reads between 105*F and 120*F in the bathroom and room temperature reads 78*F. LPA observed the facility to have adequate food supply during today’s visit. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. {Cont. on 809C}