Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 10:20 am to conducted a 1 year annual visit to the facility above. LPA met with Administrator David Keefe 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 hand sanitizer 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 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 6 bedroom, 4 bath home. 4 bedrooms and 2 bathrooms are dedicated for resident use. The Licensee/Administrator are live in and occupy the other 2 bedrooms and 2 baths. The facility census is 3 residents in care, 2 live in staff, 1 regular staff and 1 on call staff. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke alarms and a carbon monoxide detector (CM). CM was tested and alarmed properly. 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 storage closet off the kitchen. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard with furniture for resident use. The facility has telephone and internet service for resident use. Water temperatures were tested and within regulation requirements, bathroom #1 measured at 114.4F. Continued 809-C