Facility Evaluation Report

Licensing Program Analyst (LPA) Delmundo conducted an unannounced infection control annual inspection. LPA met with staff, Melinda delos Santos and Belinda dela Cruz and informed the purpose of visit. LPA requested to call Marcial Julian, licensee-administrator, who arrived after several minutes.

Facility has an approved LIC808 COVID-19 Mitigation Plan. Staff were fit tested for N95 respirator.

LPA started inspection with delos Santos and continued with Julian. LPA observed screening station located near the front entrance with visitor's log, hand sanitizer, surgical masks and no touch temperature probe. Visitors are screened for symptoms and temperature and recorded on visitor's log. Routine symptom screening (+/-) temperature and symptom checks are done for all staff and residents, and recorded daily. Trash bins were observed with pedal operated lids. Centrally stored PPEs inspected. Facility has updated visitor's poster posted on entrance door. Facility has COVID-19 signages/posters.

Fire extinguisher was observed fully charge; however, tag showed serviced October 12, 2020. The 2 in 1 smoke and carbon monoxide detector was observed operational. First aid kit inspected and observed complete with manual.

1. Expired pineapple juice, Ranch salad dressing, Thousand Island salad dressing, orange juice, mayonnaise, V8 Splash juice.

2. Supply of disposable gowns not sufficient for 30 days for 4 staff.

LPA received on this day a copy of proof of $3M liability insurance coverage.