Facility Evaluation Report
On 9/23/2022 at 11:55AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct an Infection Control Inspection. LPA met with LVN, Tiruwork Guangul and explained the purpose of the visit. Administrator, Sophia Tekle arrived 30 minutes later.
Upon entry, LPA's temperature was checked and COVID-19 questionnaire was asked. LPA completed visitor's log. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, living room, garage, and outdoor areas. LPA observed sign & symptoms, cough etiquette, and social distancing were posted in the common areas. Hand washing posters were posted at bathrooms and sinks.
During record review, LPA observed visitors log and temperature logs for clients and staff. LPA observed facility has a copy of Mitigation Plan on file. LPA observed facility staff completed fit testing for N95 respirator and documentation of certificates. LPA observed PPEs, food, and paper supplies are sufficient.
At 12:15PM, LPA observed unlocked lighters in the kitchen drawers. Staff locked up the lighters during inspection.
The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiency by POC date may result in additional Civil Penalties.
Exit interview conducted. A copy of this report and appeal rights provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction