Facility Evaluation Report

Licensing Program Analyst (LPA) Arlene Garcia conducted an unannounced annual / Infection Control visit on this date. LPA met with Augusta Nkwocha, Licensee (AD).

LPA and AD, inspected physical plant including but not limited to the main kitchen, residents bedrooms and bathrooms, and dining/ living room areas.

Hot water temperature measured 114.4 degrees in residents bathroom with the AD which is in required range of 105 to 120 degrees.

Last Fire Drill conduced 5/8/21. Fire extinguishers maintained 5/3/2021. Fire alarm and carbon monoxide functional. First Aid pack complete. Emergency contact information updated 3/21/2021. LPA and AD observed centrally stored medications.

LPA reviewed 4 staff and 4 resident files. Resident emergency contact complete. LPA reviewed staff files. S1 was missing TB test and proof of health screen .

Administrator Certificate valid until 6/24/2023.

All persons in facility fully vaccinated with exception of 1 resident due to personal reasons. LPA observed practicing social distancing. LPA observed 30 days PPE supply.