Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 10:15 am to conducted a 1 year annual visit to the facility above. LPA met with Licensee Alicia Hawke and explained the purpose of the visit.

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

Infection Control: The facility has a current Infection Control Plan. 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 when and if needed. Staff are trained on infection control and the use of Personal Protective Equipment (PPE).

Physical Plant & Environment Safety: The facility is a 4 bedroom and 3 bath home, two bedrooms and 1 bathroom are designated for resident use. Facility has 1 common area bathroom for residents and visitors, and 2 bedrooms for live-in Licensee and family. The facility is currently occupying 3 residents and employs 3 staff and 1 Administrator. 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 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 and locked under the kitchen sink, and in laundry room cupboards. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for resident use with shade and two self closing self latching gates. Telephone and internet services are provided for resident use. The facility has a working washer and dryer. Continued 809-C