Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 10:30am to conducted a 1 year annual visit to the facility above. LPA met with Administrator Adam Calloway 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 submitted a current Infection Control Plan to the department. The facility has a sign in and out binder for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, and hand soap. 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).

Physical Plant & Environmental Safety: The facility is a 3 bedroom, 2 common area bathrooms currently occupying 5 residents and employs 11 staff with 1 being Administrator. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke alarms and one monoxide carbon detector. The lighting and lamps are sufficient for the use of the facility and for residents comfort. The facility kitchen is clean, safe and sanitary. Toilet, hand washing and bathing facilities are operational. 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 locked in cabinet in garage. The facility has sufficient space inside and outside for activities and visiting with a shaded area for residents use. The facility has a backyard with a side yard gate, self closing and self latching. The facility has telephone and internet service for resident use. Water temperature was tested in bathroom #1 measured at 111.0 F and bathroom #2 110.6 F.

Operational Requirements: The facility has a current plan of operation with the department. The Facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity 6 with 5 being Ambulatory and 1 being Non-Ambulatory. The facility has exiting door alarm at front entry. Continued 809-C