Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an annual inspection visit, and met with administrator (ADM) Marlene Elliott. Upon arrival, ADM took LPA body temperature, asked the questionnaires of infection control and checked LPA into the guest book. Screening station with thermometer, masks, hand sanitizer was observed at the main entrance. COVID posters were observed at the main entrance and in facility. 2 staff and 3 residents were observed in facility.

LPA toured the facility inside out with ADM. LPA inspected living room, family room, kitchen, dinning area, and laundry room. Medication closet, knives closet, and cleaning product closet were observed locked. There are 2 bedrooms for residents, and two restrooms for residents. There are 4 bedrooms and two restrooms for ADM family. Paper towels were observed with holders, trash cans in facility were observed with covers. Room temperature was observed at 68 degree F, and hot water temperature was observed at 106 degree F. 2 days perishable food supplies and 7 days non perishable food supplies were observed sufficient. PPE supplies were observed sufficient.

The facility is equipped with smoke and carbon monoxide detectors. ADM tested the smoke and carbon monoxide detectors, and they were working fine. The fire extinguishers were observed on service on 08/12/2021. LPA inspected the backyard, there was no obstruction to block the walkway. There was a swimming pool at backyard. There are fences with gates locked around the swimming pool.

ADM stated all staff and residents are fully vaccinated and done with booster.

No deficiency or issue noted during inspection. Exit interview was conducted with ADM. This report was provided to ADM for signature.