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 met with House manager Emmeline Baldoza and Administrator Fransica Chamu-Nesto and explained the purpose of the visit. Home is Specialize home. The home has 5 ambulatory clients, none have a restricted health care condition and 2 clients are between the ages of 18-59. 3 clients are over 60 and facility has age exemption for 2. Facility is a one-story home located in a residential area consisting of 5 private rooms and 2 staff rooms,2 bathrooms, 1staff bathroom, living room, dining room, backyard patio area, and detached garage. The last fire drill was completed on March 21,2022. Administrator certificate expires 10/08/2023

· 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 no designated isolation room as residents have private rooms that can serve that purpose.

· Five (5) 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

· Five (5) centrally stored client medication records were reviewed.

· Staff responsible for direct care and supervision were observed wearing masks.

· Clients were not present during visit..

· 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.

· Deficiencies cited (see 809D for details)

Exit interview was conducted with Assistant Administrator Fransica Chamu-Nesto. A copy of the report was provided.