Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 2:00pm to conduct a 1 year annual visit to the facility above. LPA met Administrator Connie Ray and explained the purpose of the visit.

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

Infection Control: The facility has a current infection Control Plan on file. The facility has a sign in and out note pad with hand sanitizer at garage door entry. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). All trash cans and waste baskets have tight fitting covers.

Physical Plant & Environmental Safety: The facility is a 3 bedroom and 3 bathroom currently occupying 4 residents and employs 5 staff, 1 Administrator and 2 back up staff if needed. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. Carbon Monoxide detector was tested and alarmed properly. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe and sanitary. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and locked in garage or under locked kitchen sink. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard and front yard for client use. The facility has a gate one on each side of the house and do to normal wear and it is no longer self closing and self latching, Administrator will have staff fix gate. The facility has telephone and internet service for resident use. Continued 809-C