Facility Evaluation Report

Licensing Program Analyst (LPA) Delmundo conducted an unannounced annual/infection control inspection. LPA met with care staff, Celine Medina and Angeles 'Gil' Jonson, and informed the purpose of visit. LPA called and spoke with Joseph Crisol, administrator. Administrator stated he can not come to the facility to meet LPA and authorized Celine Mediina to sign and receive this report.

Facility has an approved LIC808 Mitigation Plan on file. Administrator has not submitted the new Infection Control Plan and started he'll submit before the end of the day today.

LPA toured the facility inside out with Medina. LPA inspected the living and dining rooms, kitchen, hallways, bathrooms. bedrooms, side and backyard. There's adequate food supplies of perishables good for 2 days and non-perishables good for 7 days.

LPA observed screening station near the front entrance with hand sanitizer, no touch temperature probe, sanitizing wipes and Visitor's Log. Visitor's temperature and symptom checks are done at the entrance. Residents and staff are screened for COVID-19 symptoms, and temperature checked and recorded daily. Facility keeps record of proof of vaccination of residents and staff. Supplies of PPEs checked and observed adequate for 30 days, and antigen test kits are readily available. Trash bins were observed with foot pedal operated lids. Bathroom lavatories were observed with liquid soap and paper towels. Staff were fit tested for N95 respirator August 19, 2021. LPA verified, and administrator stated re-certification is scheduled for October 3, 2022.

Fire extinguisher checked and observed fully charge with tag showed serviced April 21, 2022. Hot water temperature in one of the common bathrooms was tested and measured at 105 degrees Fahrenheit.