Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Administrator Carmen Galicia. There are currently 58 elderly residents 60 years and older residing in the facility. One resident (1) is receiving hospice care.

The following 12 (CARE) tool domains were utilized during the inspection: Infection Control, Operational Requirements, Physical Plant/Environment Safety, Staffing, Personnel Records/Staff Training, Resident Records/Incident Reports, Planned Activities, Food Service, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs.

Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance lobby. Room # 232 is designated as a COVID-19 isolation room if needed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan.

A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan.

The facility does not have a Dementia Waiver in place. A Hospice Waiver for 8 is approved.

A fire clearance for 20 ambulatory and 68 non-ambulatory residents is in place.

Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 1/1/2024.