Facility Evaluation Report

On June 21, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced infection control inspection. Upon arrival, LPA observed the COVID-19 signage posted at that front door. LPA met with facility manager, Coryse Ngangmenyi and Administrator, Phil Surdel joined shortly thereafter. LPA was screened at entry point and the manager was able to provide screening log documentation for residents, staff, and visitors.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a single story facility with 4 bedrooms; 2 private rooms and 2 shared rooms. LPA observed the 2 shared rooms with beds 6ft apart. LPA observed the tqo bathrooms to be in good repair and odor free. According to the Administrator, liquid soap and paper towels are not in the bathrooms because resident's are unable to maintain it because of their behaviors. LPA toured the kitchen and advised Administrator to not keep any hand-towels and to ensure all trash cans have lids.

LPA observed 2 day perishable and 7 day non-perishable. LPA observed the 30-day PPE supply. Medications, toxins and sharps are stored appropriately and inaccessible to residents, and a comfortable temperature is maintained, lighting is sufficient for comfort. First aid kit was observed to be completed. Extra linen was observed to be present. Washer and dryer was observed to be in good working condition.

LPA requests for the following to be sent to CCLD by 6/28/22:

LIC308 Designation of Administrative Organization

Report is reviewed with Administrator, and a copy is provided.