Facility Evaluation Report

Unannounced Annual visit made out to this facility on 08/25/2021 by LPA Charlie Yang and was met by a facility designated representative, Clayton Forrest, who was briefly interviewed. It was learned that this program maintained a 6 clients to 1 staff ratio at all times.

Kitchen area was toured. Cabinets and drawers were reviewed for adequate plates, glassware, and dinnerware sufficient to meet the needs of the residents at this time.

Food supply was not reviewed for 2-day perishable and 7-day nonperishable quantities since the attendees to this program brought their own lunches and snacks on a daily basis.

Medication cabinet, located in the office of manager, was reviewed. Policies and procedures for medication dispensing, documentation, and control were discussed with the facility designated representative. First aid kit was observed to be present and contained all required components at this time.

A tour of the several rooms and spaces intended for client use were toured. A tour of the resident restroom was conducted.

Hot water temperature was taken to make sure that it was within the allowed range of 105-120 degrees.

Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 08/20/2021 and in compliance at this time.

A tour of the facility exits was conducted. Mitigation plan and procedures were discussed with the facility designated representative.

There were no deficiencies observed or cited during today's annual visit.

The following forms and documents were requested by this LPA to be completed and submitted into CCL: