Facility Evaluation Report

On 9/8/2022 at 12:50PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct an Infection Control Inspection. LPA met with caregiver, Amelia Domanillo. Administrator, Thera Albers arrived 30 minutes later.

Upon entry, caregiver did not conduct COVID-19 screening for LPA. LPA observed hand sanitizer at screening station. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common areas, garage, and outdoor areas. LPA observed cough etiquette, signs & symptoms, and physical distancing are posted in the common areas. All bathrooms were equipped with soap and paper towel. Hand washing posters were posted at sinks and bathrooms.

During record review, LPA observed visitors log and temperature log for clients and staff. LPA observed facility has a copy of Mitigation Plan on file. LPA observed PPE, food supplies, and paper supplies are sufficient.

At 1:10PM, LPA observed unlocked staff room where staff's prescription medications were unlocked. Staff locked up the prescription medications during inspection.

At 1:15PM, LPA observed multiple bottles of isopropyl alcohol stored next to food supplies and snacks. Staff locked up the isopropyl alcohol in a different location during inspection.

At 1:20PM, LPA observed screen door was broken near the handle. Also, there were lots of items along the side yard near the exit gate including old furniture and other items.

At 1:25PM, LPA observed unlocked cleaning supplies in the hallway bathroom. Staff locked up the cleaning supplies during inspection.

The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights was provided.