Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Annual Inspection at the facility today, with an emphasis on Infection Control practices and procedures. LPA arrived at 12:14PM and initially met with facility staff Estrella Ozuna. Entrance interview conducted. A tour of the physical plant was conducted with the facility staff Estrella Ozuna at 12:20PM and the following observed:

Fire extinguishers located throughout the facility were observed to be fully charged and last serviced on 07/26/2022.

KITCHEN: Appliances and fixtures appeared clean and functional. There was sufficient perishable and nonperishable food observed. Cleaning supplies are stored in locked under-sink cabinets. Knives and other sharps were observed to be inside a locked office. There were no visible immediate hazards observed.

BEDROOMS: There are three (3) Bedrooms, all of which are designated for client use. All bedrooms are located on the second story and furnished for double occupancy. All bedrooms were equipped and supplied with appropriate furniture, bedding and linens. There were no visible hazards or discrepancies observed.

BATHROOMS: There are six (6) Bathrooms, two (2) on the ground floor and four (4) on the second floor. The bathrooms located on the ground floor include a half bath in the main hallway for client use and a full bath attached to the office designated for staff use. The bathrooms located on the second floor are all full bathrooms and three (3) are designated for client use. 1 upstairs bathroom is designated for staff use only. All Bathrooms were supplied with appropriate soap and paper towels. Water temperatures were measured

in all client bathrooms and measured within the required range of 105 degrees F to 120 degrees F at the time of the visit. Report Continued on LIC 809-C