Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with Licensee Catherine Olds. The inspection is focused on the Infection Control procedures and practices of this facility.

Upon arrival, LPA confirmed that facility is no longer requiring vaccination verification per recent guidance. LPA observed the following: Facility has COVID-19 posters throughout that include hand washing signs in bathrooms. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is located throughout common areas of the facility. Commonly touched surfaces are disinfected at least twice per day. Facility does perform daily screening of staff and residents and documents it. Facility will be allowing for visitation in resident rooms per CCL guidance. Staff continue to receive training on infection control, donning and doffing of Personal Protective Equipment PPE and have been N95 fit tested. Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has more than a 30 day supply of PPE including but not limited to masks, gowns, and hand sanitizer. Facility maintains a 30 day supply of medication. All staff and clients have been vaccinated. Last disaster drill conducted on January 2023. Fire extinguishers was last serviced September 2022. Smoke Detectors and Carbon Monoxide detector were operational. All clients do not attend to in-person day program, but they do attend to online classes daily and the facility provides activities for them.

Facility will provide copies of the following documents by 2/23/23: Designation of Responsibility (LIC308), Affidavit Regarding Client Cash Resources (LIC400), Surety Bond, Personnel Report (LIC500) and LIC 610 Emergency Disaster Plan (if any changes).

Exit interview conducted with Licensee and a copy of this report was given. No deficiencies cited during today's inspection.