Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon Conducted a 1 year Annual Visit to the facility above. LPA met with Kristin Hodge, House Manager and back up to Administrator. LPA explained the purpose of the visit.

LPA requested the entrance records Staff Roster, Resident Roster, Emergency Intervention Training for all staff working at the facility and Emergency Disaster Plan. LPA requested 4 resident files and 5 staff files for review. LPA interviewed 1 staff and all clients out of facility could not interview.

A tour of the inside and outside of the facility was conducted with Administrator. 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 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 annually on infection control and the use of Personal Protective Equipment (PPE).

Physical Plant & Environmental Safety: The facility is a 4 bedroom with one on suite bathroom and 2 common area bathrooms, currently occupying 4 residents and employs 10 staff with 1 Administrator. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke alarms and a two carbon monoxide 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. Continued 809-C