Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 2:00pm to conducted a 1 year annual visit to the facility above. LPA met with Licensee/Administrator Rosita "Vicky" Manuel and explained the purpose of the visit.

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 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, hand soap, and hand washing signs. 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). All trash cans and waste baskets have tight fitting covers.

Physical Plant & Environment Safety: The facility has 4 resident bedrooms, 1 resident bathroom and 1 common area restroom, currently occupying 4 residents and employs 2 full-time staff and 1 administrator, and 5 back up/on call staff. The facility has 1 bedroom for live-in staff. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe and sanitary. 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 are locked under the kitchen sink and in the locked garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for resident use with plenty of shade. Telephone and internet service is provided for resident use. The facility has a working washer and dryer. Continued 809-C