Facility Evaluation Report

Licensing Program Analysts (LPAs) Alberto Lopez and Sakinah Madyun conducted an unannounced annual subsequent inspection visit. LPA met with facility Administrator, Jennifer Sandoval. The purpose of today's visit was discussed. The facility has a capacity of 4 residents. It is licensed to serve elderly residents aged 60 and above, approved for 4 non-ambulatory residents of which 1 may be bedridden. The facility has two (2) Hospice Waivers on file. Annual licensing fees are current.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan.

2. Operational Requirement: Liability Insurance is updated and in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place.

The Passageway in the front of facility may present an obstruction, due to storage of RV camper parked in front of facility. Facility Administrator was advised to contact the fire department and get clearance to continue to have the camper parking in that space.

4. Staffing: The facility has sufficient staffing, and the night supervision staff have current CPR/first aid certification. (continue on 809C)