Facility Evaluation Report

Licensing Program Analyst (LPA) Walters arrived at the Adult Residential Facility (ARF) unannounced to conduct Required- 1 Year visit. Administrator, Joannalyn Agbayan (6043858735 exp 3/28/23) granted LPA entrance into the facility. Licensee, Evelyn Samson was not available for today's visit. LPA learned that Licensee, Evelyn Samson is no longer the Administrator for this facility. This inspection will focus on the infection control procedures this facility.

This facility is a single-story home with 6 bedrooms: 2 bedroom for staff and 4 bedroom for clients. There are currently 4 clients residing in this facility. At the time of the inspection 3 of 4 clients were attending day program. In the event of an outbreak, the clients are able to maintain distancing in each room. The facility operates with 24 live-in hour staffing that provide care and supervision.

At the entrance of the home, there is a table with sanitizer, disposable mask available for visitors. There was also a Hiro sanitizing mister to remove bacteria from clothing items and air in the common area for clients. Visitors are asked to sign in, take temperature and complete screening questions. There are separate screening sheets for staff and clients. Clients temperatures are checked daily and logged. Current Provider Information Notifications regarding COVID are stored in a binder along with instructions on how to don and doff mask for staff. Vaccination records for cleints and staff are stored in perspective folders and easily accessible. If clients or staff become symptomatic there are spare COVID test available. Results of the test are documented in a binder.