Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 10:00am to conducted a 1 year annual visit to the facility above. LPA met with Back up to Administrator Program Director Shannon Thompson 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 Adult Day Program (ADP) has submitted an Infection Control Plan to the department. The facility has a sign in and out binder for visitors at entry. 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 placed in isolation room until picked up from program. Staff are trained on infection control and the use of Personal Protective Equipment.

Physical Plant & Environmental Safety: The facility has 1 large Reach room, 1 large activity room, Several changing stations with privacy, 3 Client restrooms, Kitchen, 1 staff office, 1 staff restroom, 1 staff break fwith storage room, 1 outside storage room attached to the back of the facility, currently occupying 7 clients and employs 10 staff, 2 volunteers and 1 Administrator. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke and 1 carbon monoxide detectors. The lighting is sufficient for the use of the facility and for clients comfort. The facility kitchen is clean, safe and sanitary. Toilet and hand washing facilities are operational with secured grab bars. The pathways are clear of any obstructions. Disinfectant, cleaning solutions and poisons are inaccessible to clients in care locked under kitchen sink. The facility has sufficient space inside and outside for activities and visiting. The facility has telephone and internet service for clients. Water temperatures were tested in Client bathroom #1 measured 116.2 F.

Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 30 and 15 of those clients can be Non-Ambulatory. Continued 809-C