Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and met with House Manager, Jhanell Edmalin. Benjamin Cabie (Licensee) was out of town but gave authorization to House Manager to sign the report. LPA conducted a Risk Assessment with House Manager. LPA/House Manager reviewed PIN 22-05, PIN 22-06 and PIN 22-07.

LPA arrived at the facility and had their temperature checked and logged into a sign-in sheet. LPA observed that facility has posters on the front door indicating visitors about updated visitor's policy to protect residents in care. Once inside the facility, LPA observed that staff were wearing masks during this visit.

LPA/House Manager conducted a walk-through of the facility and observed Covid-19 posters that included hand washing signs. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer was not observed in the common area of the facility due to safety reasons. Facility bathroom are kept stocked with hand hygiene products. Commonly touched surfaces are disinfected at least twice a day. Facility is able to accommodate a single room for each resident that needs to isolate and is able to serve meals and deliver medications. Facility staff have been trained on PPE protocols, but have not been N-95 fit tested. Staff and residents are being monitored daily and results are documented. Facility maintains a 30 day supply of medication. Facility has a 100% vaccination rate and received boosters for staff and clients. Clients do not typically wear a mask while in the facility, but they do wear masks when in the community. Two clients do attend to virtual classes through zoom with their Day program and day program drop off arts and craft supplies for the other 2 clients, but facility provides activities for clients at home. Clients do not receive indoor visitation from their families, but they have access to phone calls and online communications. Facility has submitted their Covid Mitigation Plan and approved on 1/27/21. Facility has enough PPE supply including masks, face shields, hand sanitizer and they are located in an accessible place for staff. House manager will provide updates of the following by 2/14/22: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), affidavit regarding client/resident cash resources (LIC400), surety bond and Emergency Disaster Plan (LIC610E).

No deficiencies cited during this inspection.