Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. This annual had a specific emphasis on infection control practices and procedures. Upon arrival, LPA met with Administrator Angel Arabaca and explained the reason for the visit. Entrance interview conducted.

At 12:34PM, LPA along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

Bedrooms: There were seven (7) bedrooms total with one (1) bedroom designated for staff use and six (6) private resident bedrooms. LPA observed staff room to be locked at the time of the visit. All bedrooms for resident use were properly furnished and had appropriate bedding and linens.

Bathrooms: There were two bathrooms designated for resident use. Both bathrooms appeared clean, properly supplied and had functional fixtures, including grab bars and non-skid shower surfaces. Water temperature was measured in the common hallway restroom at 12:39PM and measured at 110.5 degrees Fahrenheit, which is within the required range.

Common Areas : These included the living rooms and dining areas. The common areas were properly furnished and all furnishings appeared to be clean and in good condition at the time of the visit.

Surrounding Grounds : The garage is attached to the home. Emergency/disaster and PPE supplies are properly stored in the garage inaccessible to residents in care. The laundry area was located in the garage with cleaning supplies inaccessible to residents at this time. LPA observed a shaded seating area with