Facility Evaluation Report

On 6/6/22 at 2:00 PM, Licensing Program Analysts (LPAs) K. Nguyen and C. Lin arrived unannounced to conduct Infection Control Inspection. LPAs met with Rayan Jayson V. Carvajal Administrator to explain the purpose of the visit.

During the Infection Control Inspection, LPAs toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and backyard. Facility has a sufficient 2-day perishable and one-week non-perishable food supply. Visitors policy is posted on the front entrance. There is one central entry point for universal screening for staff, residents, and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. Facility has a mitigation plan.

During record review, LPAs reviewed a sample of 2 staff records and observed 2 of 2 have health screening with TB test on file.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 6/13/2022:

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.