Facility Evaluation Report

On 1/10/22, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry. Administrator (ADM) Ofelia Nebrida arrived a short time later.

LPA toured inside and outside of facility. No obstructions observed. No fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bedrooms were checked and no residents share a room. LPA checked residents’ medications and observed the month's supply. Food supply was observed in adequate supply. Cleaning and PPE supplies were checked. Staff records were reviewed for good health. Residents files have updated emergency contact information. Administrator certification is valid.

The following updated forms to be sent to CCL within 2 weeks:

LIC500, LIC610E (new version), LIC400, LIC402

Exit interview conducted. Due to COVID-19 precautionary measures, a copy of this report will be emailed to ADM with "Read receipt" to confirm receipt of this report.