Facility Evaluation Report

A Required One (1) year - Infection Control visit was conducted today by Licensing Program Analyst (LPA) Gary Tan. LPA met with Administrator Nazareth Duenas and explained the purpose of the visit. LPA observed that three (3) residents were at the facility during visit.

A tour of the physical plant was conducted at 9:45 AM and the following was noted:

The front main door is the only entrance being utilized at the facility. There is a sign on the front door that everyone entering at the facility must be screened. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask.

The facility had submitted and approved Mitigation and Infection Control Plan.

The facility is a single storey home with four (4) private client bedrooms and three (3) bathrooms. One (1) bathroom is designated for the staff and visitors. There is no body water in the facility.

Bedrooms were toured and observed to be clean and properly furnished. Linen storage was also checked and observed to have ample supply of clean linen and towels.

Bathrooms were observed to be clean and sanitary with necessary supplies. Hot water temperature measured at a range of 105.6°F to 114.3°F and within the required range.

Physical plant was checked for cleanliness and condition. Facility was in good repair and observed to be clean and free of clutter during today's visit.

Living, dining & study room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition.