Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection, and met with House Manager (HM) Editha Retuta.

Upon Arrival, HM took LPA's body temperature, and checked LPA in the visitor log book. LPA observed the COVID posters in the facility. One staff and five residents were observed in facility.

LPA toured the facility inside and out with HM. LPA inspected living room, dinning room, kitchen. There are 2 restrooms, 3 resident rooms, and 1 staff live-in room in facility. Trash cans were observed without covers in facility. HM stated the facility will put all the trash cans with covers within 7 days. Posters of washing hands for 20 seconds were not observed by the sinks in restroom and in kitchen. HM stated the facility will put the posters of washing hands for 20 seconds in kitchen and restrooms within 7 days. Cloth towels were observed in kitchen and in restrooms. Paper towels were observed with holders. Two days perishable foods and seven day non perishable foods were observed sufficient. Room temperature was observed at 70 degree F, hot water temperature was observed at 110 degree F. Medication cabinet, Knife closet, and cleaning products closet were observed locked. Fire extinguisher was serviced on 11/21/2022. The facility was equipped with smoke and carbon monoxide detectors. Smoke detector alarm system was tested, and was working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways.

HM stated all the residents and staff are fully vaccinated and done with booster shots. ADM already submitted the Infection Control Plan to LPA.

No citation was issued today. Exit interview was conducted with HM. This report was provided to HM for signature. A copy of this report was provided to HM.