Facility Evaluation Report

Licensing Program Analysts (LPA's ) Alberto Lopez and Tena Herrera conducted the required annual inspection. LPA's arrived unannounced and met with Licensee Irene Imperial and Administrator Nicanon Imperial who assisted with the visit. The purpose for the visit was explained. The facility is licensed for 6 residents ages 60 and over. The fire clearance is approved for 6 ambulatory residents of which 5 may be non-ambulatory and one bedridden. There is a hospice waiver approved for 1 residents.

LPAs utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents and medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan posted by the entrance.

Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. There are currently 3 non-ambulatory residents and 1 ambulatory resident residing at the facility. The facility has the sufficient amount for liability insurance covering injury to residents and guest.

Physical Plant & Environment Safety: . There are 4 bedrooms, 2 bathrooms, living room, dining room, kitchen, and an attached garage. Facility has operable smoke and carbon monoxide combo detectors located in each room and hallway. Knives, cleaning solutions, and disinfectants are locked in the cabinets. But knives and cleaning solutions were stored together. No firearms or weapons are stored at the facility. LPA measured the hot water temperature in the bathrooms and kitchen sink. The hot water temperature in the bathroom and kitchen were measured between 113.0-114.6 degrees F which are within the required range of 105-120 degrees.