Facility Evaluation Report

Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Mirna Cuevas and discussed the purpose of today's visit. Kenny Yu (Operations Manager) arrived at approximately 8:25 A.M. David Yu (Administrator) arrived at approximately 8:50 A.M.. Vanessa Ricchiazzi (Administrative Consultant) and Jennifer Sandoval (Wellness Director) arrived at approximately 9:20 A.M..

This home consists of (6) private bedrooms, (4) bathrooms, kitchen, dining area, laundry room, office, sun room and detached garage. This facility is licensed for (6) non-ambulatory beds which (6) may be under hospice care and (1) may be bedridden. There are currently (5) residents under hospice care (R-2 through R-5). There is (1) bedridden resident (R-6).

COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility and throughout the facility. Signs are posted to promote hand washing, cough/sneeze etiquette, and physical distancing were observed.

PPE supplies observed. Incontinence care supplies observed. Each Resident has their own incontinence supplies stored inside their bedrooms.

Bathrooms have hand soap, paper towels, grab bars and non-skit mats. Bathrooms have hand washing signs posted.

Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed.

Medication reviewed for Resident #1 through Resident #6 (R-1 through R-6).

Staff responsible for direct care and supervision were wearing masks.

Residents were socially distanced according to local public health guidelines.

Exit interview conducted, a copy of this report and Appeal Rights were provided to David Yu and Vanessa Ricchiazzi