Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Manager Patricia Garcia and explained the purpose of the visit. The facility is licensed for 17 non-ambulatory adults 60 and over. he facility has a hospice waiver for 2 residents. The facility is composed of 6 single story detached "Casitas" rooms, dining room/kitchen area, garages [3 converted into office space], medication room, and a center courtyard area. Administrator certificate expires 6/26/2022.

The main entrance was locked. A wire was observed on the very top of the metal gate that prevents anyone inside the property from exiting in case of an emergency. Rear gate had a lock on right door.

COVID-19 screening, sign-in sheet, and temperature check was not conducted by staff upon entry, or to other visitor's observed.

COVID-19 Infection Control Practices and signs were observed in resident rooms, common areas, and throughout the facility.

The interior and exterior physical plant was inspected. Six (6) rooms were inspected. A signal system was observed to be operational. Breakfast was served at 10:00 AM. Lunch service was at 1:00 PM.

Resident rooms are designated as a COVID-19 isolation rooms if needed.

All staff were observed wearing mask. Residents in care were not observed wearing masks due to health issues.

Centrally stored resident medication records were reviewed. MAR records did not match MD orders.

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

A posted Emergency Disaster Plan was observed.

Facility has sufficient supply of Personal Protective Equipment (PPEs).

Emergency Disaster drill records were not found. Disinfectants/cleaning solutions were observed in Dementia residents rooms.

***Deficiencies were cited. See LIC 809D.

Exit interview was conducted with Manager Patricia Garcia. A copy of the report and appeal rights was provided.