Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez and Bennette Pena conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPAs were greeted by DSP Vicente Toh and Director Sabrina Godinez arrived a short time later and LPAs explained the purpose of the visit. Home is a specialize home. The home has 3 ambulatory clients, none have a restricted health care condition and all clients are between the ages of 18-59. Facility is a one story home located in a residential area consisting of 3 private rooms and, 2 bathrooms, living room, dining room, backyard patio area, and detached garage. The last fire drill was completed on April 11, 2022. Administrator certificate expires 08/21/2023

· COVID-19 signs are posted at the entrance. Visitors are screened in the main entrance and a log is kept.

· Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen, and hallway to promote handwashing, cough/sneeze etiquette, and physical distancing.

· Facility has designated isolation room; as each resident has private room.

· Three (3) resident rooms, common areas, bathrooms, and outdoor physical plant was inspected.

· All client rooms were not equipped with alcohol-based hand sanitizer but available throughout the facility

· Three (3) centrally stored client medication records were reviewed.

· Staff responsible for direct care and supervision were not observed wearing masks initially but put them on shortly thereafter.

· Clients were not observed wearing masks but adhering to public health social distance guidelines.

· Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.

· A posted Emergency Disaster Plan was observed.

· Staff and resident files were not reviewed during today's visit.

Exit interview was conducted with Director Sabrina Godinez. A copy of the report was provided.