Facility Evaluation Report

On 6/15//2022 at 3:35PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Aurora Balancio, Administrator , and explained the purpose of the visit.

Upon entry, LPA temperature was not checked. LPA observed screening station that contained hand sanitizer and COVID signage. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, kitchen, garage, and back yard. LPA observed cough etiquette and physical distancing posted in the common areas. All hand washing stations were equipped with soap, paper towel, and hand washing poster. Hot water temperature in the shared residents' bathroom was measured at 105.1 .degrees Fahrenheit. Fire extinguisher was serviced on 3/20/2021.

During record review, LPA observed facility has a copy of Mitigation Plan on file. LPA observed food, PPE and paper supplies are sufficient.

The following forms are to be updated and submitted to CCLD by 6/22/2022 :

-LIC9020 Register of facility Clients/Residents

-LIC308 Designation of Administrative Responsibility