Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 10:30 am to conducted a 1 year annual visit to the facility above. LPA met with staff that called Back-up Administrator Edwin Ingan to come to the facility. LPA met with Edwin Ingan at 11:30 am and explained the purpose of the visit.

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

Infection Control: The facility has submitted a current Mitigation Plan, Infection Control Plan and an up to date Emergency Disaster Plan to the department. The facility has signs in the common areas regarding Covid-19. The facility has a sign in and out binder for visitors at entry with hand sanitizer and symptom screening. 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 trash bins with covers. The facility has a 30 day supply of PPE. New residents are tested and negative results received before residing in the facility. Sick staff are requested to stay home and not report to work if ill.

Physical Plant & Environment Safety: The facility is a 3 bedroom and 2 bathroom home currently occupying 4 residents and 6 staff. The water was tested in resident bathroom #1 and measured at ____. The facility is clean, safe and sanitary. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. The gates are self closing, one gate is self latching and one gate needs repair to be self latching. The kitchen screen door needs to be repaired put back on track to open and close properly.The facility has table and chairs available outside with shaded area for resident use. Laundry room has working washer and dryer.