Facility Evaluation Report, 10/25/2021 — A and M IV Home Care, Claremont CA

Licensing Program Analyst (LPA) Spencer conducted an unannounced annual inspection focusing on the Infection Control Domain. LPA Spencer met with licensee Monaliza de la Rosa and assistant administrator Roberto Ronas and discussed the purpose of today's visit. This single-story home contains four (4) client bedrooms, two (2) bathrooms, a living room, kitchen, dining area, and backyard.

The facility had a universal entrance screening area including a thermometer, screening log, and hand-sanitizer. COVID-19 signage was placed in several areas and temperature logs were maintained.

Facility maintained a 30-day supply of PPE.

There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods.

Sharps were observed to be accessible. At 10:09 a.m., LPA observed that the knife drawer in the kitchen was unlocked. The staff immediately locked it.

All areas were observed to be clean and in good repair.

Each room contained required furniture: bed, dresser or drawer space, night stand, lamp and chair.

All beds contained the required linen including mattress cover, fitted sheet, flat sheet, blanket, and comforter.

Bathrooms contained supplies including liquid soap, toilet paper, and paper towels.

Medications were locked, centrally stored, and given as prescribed. 30-day supply was maintained.

Staff wore face masks consistently throughout the shift.

Smoke detectors/carbon monoxide detectors were present and operable.

A fire extinguisher was observed to be fully charged and last serviced January 2021.

All client files were inspected: emergency contact information and physician's reports were up-to-date.

Four (4) staff files were inspected and contained required health screenings, criminal record clearances, first aid/CPR and training certificates.

An updated administrator certificate was observed and expires on 1/10/23.

Pursuant to Title 22, a deficiency was cited on attached 809D. An exit interview was conducted and a copy of this report and Appeal Rights were provided to the licensee.