Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted the required-1 year inspection. LPA was allowed entry by Loida Carlos, Caregiver and explained the purpose of today's visit. Administrator, Edgardo Francisco arrived at 11:00am and assisted with the inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

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 and was reviewed. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements.

Operational Requirements : A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. A fire clearance is in place. Liability Insurance policy in the amount of $1,000,000.00 each occurrence and #3,000,000.00 in the total annual aggregate is valid and will expire on 6/25/2024. Surety bond (Western Surety) of $2,000.00 is current and will expire on 03/04/2026 . The last fire and emergency drill was conducted on 10/05/2023. Care and supervision to meet the residents needs was observed. Special equipment and supplies to meet the persons with special needs were observed.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood that is licensed to serve 6 non-ambulatory residents ages 60 and over . Current census is four (4), of which three (3) are non ambulatory and one (1) ambulatory. Facility is being serviced by Harbor Regional Center. Home consists of four (4) resident bedrooms, 2 bathrooms, living room, dining room, family room, kitchen, backyard, and a detached garage. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors are operational. The facility has (2) fire extinguishers in the facility. One (1) fire extinguisher located in the kitchen was purchased on 6/08/2023. The other (1) fire extinguisher located in the bedroom hallway was purchased today, 11/30/2023. Both bathrooms toured were observed to be fully stocked with hand soap, and paper towels, and had the required grab bars and nonskid mats in place. All showers in bathrooms accommodate non-ambulatory clients. However, LPA observed an all purpose cleaner bottle stored in an unlocked cabinet under the sink in bathroom #1. In bathroom #2, LPA observed mold and mildew in the shower area. At 10: 50am, hot water temperature readings measured 112.2 deg F in the kitchen, 111.9 deg F in bathroom #1 and 109.7 deg F in bathroom #2 which are within the required 105-120 degrees Fahrenheit. Medication was observed to be centrally stored in the kitchen cabinet. ***CONTINUED ON LIC 809-C**