Facility Evaluation Report

Licensing Program Analyst (LPA) was met by Jose De La Cueva, Administrator and stated purpose of the visit. A tour of the facility was conducted, COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry at facility entrance/exit point, all staff and visitors enter through front door.

Facility appeared clean with no obstruction or fire clearance issues. Social distancing is maintained in the common area and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms toured, all residents have private rooms.

Fire extinguisher present and has a service date of 12/04/2021. Smoke detectors present and observed to be operational during today's inspection.

LPA checked residents’ medications and observed a 30-day supply. LPA observed a 2-day of perishable and a 7-day of non-perishable food available. Cleaning and PPE supplies were checked. Staff records were reviewed for good health and infection control training. Mitigation plan submitted to Department on 03/02/2021.

LPA provided copies of the following documents during inspection visit:: Copy of Administrator Certificate, First Aid card, LIC 500, LIC 610, and LIC 9020, LIC 308, LIC 402, LIC 309, LIC 9148 and Neighborhood Complaint Policy.

No deficiencies were observed. Exit interview was conducted. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed.