Facility Evaluation Report

On 5/13/2022 at 2:40PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA telephoned Caregiver on cell phone to come to facility. LPA met with Henry Magtibay, Caregiver at 3:10PM and explained the purpose of the visit.

Upon entry, LPA's temperature was not checked. LPA did not observe a screening station or sign-in booklets. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, kitchen, and garage.. LPA observed cough etiquette and physical distancing posted in the common areas. All hand washing stations were equipped with soap and hand washing signs. Hot water temperature in the shared clients’ bathroom was measured at 107.4 degrees Fahrenheit.

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

The following forms are to be updated and submitted to CCLD by 5/13/2022 :

-LIC308 Designation of Administrative Responsibility