Facility Evaluation Report

Licensing Program Analyst (LPA) Rankin arrived at 8:30 am to conducted a 1 year annual visit to the facility above. LPA met Licensee/Administrator Gabriella Soo and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit:

Infection Control: The facility has submitted a current Mitigation Plan, Infection Control Plan and Emergency Disaster Plan. The facility has EPA approved disinfectants spray and cleaners. The facility has trash bins with covers. The facility has a 30 day supply of PPE.

Physical Plant & Environment Safety : The facility is a 5 bedroom and 3 bathroom home currently occupying 6 residents and 4 staff, including the administrator. The facility is clean, safe and sanitary. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. The gate (on the street view right side of the facility) is being updated for ease of latching and self-closure. The facility has table and chairs available outside with shaded area for resident use. Laundry room has working washer and dryer.

Operational Requirements: The Facility is operating in compliance with fire clearance. The facility provided current up to date liability insurance. All Dementia requirements are being met. Hospice wavier granted for 2, a request to update hospice waiver to 4 is being submitted.