Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto conducted the required annual inspection. LPA arrived unannounced and met with Administrator Vincent Robles who allowed entry of the facility and explained the purpose of the visit. Shortly after the Licensee Arden Robles arrived and assisted with the visit. The facility is licensed for residents ages 60 and over, may retain a maximum of four (4) hospice residents. Currently facility has 4 hospice residents.

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: The Infection Control Plan has been added to the Operation Plan. A Hospice Waiver for 4 residents is approved. 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. 2 residents are currently bedridden according to most recent LIC602A. Facility is not licensed for any bedridden.

3. Physical Plant and Environmental Safety: The facility is a single-story house and located in a residential neighborhood area. The facility includes Dining area, kitchen, sitting room, six residents bedrooms, two resident bathrooms, one guest bathroom, laundry room, detached garage. Each resident bedroom has one bed, dresser, required beddings and furniture and sufficient lighting and closet space. The two residents bathrooms are clean, sanitary and in a good working condition. Both bathrooms have the required grab bar but not non-skid mat. The two bathrooms hot water temperature were tested between 112.2 and 116.4 degrees F. which is within the Tittle 22 regulation. All the appliances in the kitchen and living room are working well. The sharp knives are stored in a locked kitchen drawer. (Continue on 809C)