Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 9:30 am to conducted a 1 year annual visit to the facility above. LPA met with Back up Administrators Jessica Bailey and Rachelle Tellez and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted with Administrators. 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 lids/covers. The facility has a 30 day supply of PPE. The facility staff have taken annual Infection control and PPE training.

Physical Plant & Environment Safety: The facility is a 6 bedroom and 6 bathroom home currently occupying 5 residents and 7 staff, including 3 administrators. 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. Laundry room has working washer and dryer.

Operational Requirements: The Facility is operating in compliance with fire clearance. Capacity is 6 with 1 non-ambulatory and 5 bedridden with a hospice waiver for 3. The facility has current liability insurance on file. The facility has dual hard wired smoke and carbon monoxide detectors.

Staffing: The facility employes 7 staff and 3 Administrators. Staff records are kept confidential. Staff records were reviewed for 5 staff. Staff records had fingerprint clearance and associations with criminal record statements, personnel record or application, First Aid and CPR certificates and Health screening with TB results. Administrator file has all CEU/education requirements to renew Administrator Certificate, Administrators are on the active or pending list.