Facility Evaluation Report

On 09/10/2025 around 02:00 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an annual Infection Control Inspection. LPA was greeted by one staff upon entry and explained the purpose of the visit. Haidie Bautista, Administrator (ADM) was telephoned by the staff member and gave the approval for signing the report.

Facility has a COVID-19 mitigation plan, ICP & EDP on file. LPA reviewed the resident staff roster and Emergency Disaster Plan. Facility continues to screen for COVID, has hand sanitizer, COVID-19 signage, and a visitor sign-in log. LPA toured the facility including, but not limited to common areas, bathroom, kitchen, front and side pathways. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap and covered garbage cans. ADM to add paper towels to shared bathroom. There is a surplus of PPE stored centrally located inside the facility that is accessible to all care staff. The facility's temperature was 68 degrees (F) and water in shared bathroom last measured at 109.4. Fire extinguisher was observed full and expires 11/15/24. Smoke/Carbon Monoxide detectors were observed operational and first aid kit complete. A sample of sic (6) resident and three (3) staff files were complete.

The following forms are to be updated and submitted to CCLD:

-LIC308 Designation of Administrative Responsibility (Reviewed)

-LIC610 Emergency Disaster Plan (Reviewed)

-An updated copy of Administrator Certificate(s) (Reviewed)

Exit interview conducted and a copy of this report provided to Nelson Juta, Staff.