Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual inspection visit. LPA met with facility staff Laura Aguilar. The purpose of today's visit was discussed. The facility is licensed to serve six (6) non-ambulatory residents who are ages 60 and above and approved for three (6) Hospice Waivers. Facility had dementia program on file. Currently, two (2) residents are on hospice. 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 facility is a one-story home with four (4) resident rooms, two (2) bathrooms, front porch, backyard, and attached garage. Resident rooms had the required furniture and in compliance. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was measured in a range from 112.6 to 113.1 degrees Fahrenheit. Adequate linen and personal hygiene supplies were observed. Medications were centrally stored, locked and inaccessible to residents in care. Auditory device alarms are operational. Smoke detectors and carbon monoxide detectors were tested and operable. Fire extinguishers were fully charged and replaced when needed. The outdoor area has a shaped area and seating.