Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) NAWARD SMITH. Upon arrival, staff Bessy Dominguez (BD) took LPA body temperature, asked the infection control questionnaires, and checked LPA in the visitor log book.

LPA toured the facility inside out with ADM. COVID posters were observed at main entrance and the facility. screening station with masks, hand sanitizer, thermometer and visitor log book was observed at the main entrance. Living room, kitchen, dinning room and three restrooms were inspected. All trash cans were observed with covers. Paper towels were observed with holders. Cloth towels were observed in kitchen. Posters with washing hand for 20 seconds were observed by the sinks in kitchen and restrooms. Four single resident bedrooms, one shared resident room, and laundry room were inspected. The beds in shared room were observed 6 feet apart. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. PPE supplies were observed sufficient. Medication closet, knives closet, and cleaning product closet were observed locked. Room temperature was at 68 degree F, and hot water temperature was at 107 degree F in facility. Six residents and three staff were observed in facility.

Fire extinguisher was serviced on 09/08/2021. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways.

ADM stated all the residents and staff are fully vaccinated and done with boosters. No citation were noted today. Exit interview was conducted with ADM. This report was provided to ADM for signature.