Facility Evaluation Report

Licensing Program Analysts (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Administrator Virgilio Agas and the purpose of the visit was explained. The following 12 (CARE) tool domains were utilized during the inspection:

Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. An Infection Control Plan was observed

The facility is located in a residential neighborhood. It is three-story, stucco structure with 91 bedrooms, 91 bathrooms, 1 TV room, an administrative office, a restaurant style kitchen, (2) laundry rooms, a janitor storage room, an activity room, a dining room and two elevators. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. There are no bodies of water in the facility.

LPA toured room #'s 102, 104, 107, 114, 118, 212, 213, 224, 232, 305, 312 and 316.

Water temperature readings measured within title 22 regulations.

A current Plan of Operation was not observed.

A fire clearance for (200) residents of which (149) may be non ambulatory and up to (15) bedridden

Hospice care waiver approved for up to twenty-five (25) residents.

Facility has an active liability insurance. Copy was collected and reviewed

Administrator on file is current. Administrator certificate is currently active

SIx (6) staff files were reviewed. Required documents observed for files reviewed.