Facility Evaluation Report

On 4-21-23 at 10:02am, 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 2. Facility has 6 bedrooms and 3 bathrooms. There is a formal living room and family/TV room for residents. LPA observed 2 bottles of dishwashing liquid in the kitchen unlocked and accessible to residents in care. Resident rights posted. No obstructions to emergency exits noted.

The facility has submitted a COVID mitigation plan. 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 outside of facility to contain excess amounts of old mattresses, durable medical equipment, and other furniture stored along side facility backyard. Additionally, facility grounds were overgrown with shrubbery. Bathroom #1 was observed by LPA to contain broken tiles in the shower and excess dirt. LPA further observed a damaged section of a wall near the hallway leading to the bathroom 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 68*F. LPA observed the facility to have adequate food supply during today’s visit. .