Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA was greeted by DSP Brain Tria and Administrator Francis Mejia arrived a short time later. LPA explained the purpose of the visit. The home has 5 residents at time of visit. This home is licensed to serve Elderly residents age 60 and above, (6) Non-Ambulatory of which 1 may be Bedridden. This home is in a residential neighborhood and contains 5 bedrooms: 2- private resident bedrooms, 2 semi-private resident bedrooms, 1 staff bedroom/bathroom, 2 bathrooms, living room, dining room, kitchen, and a detached garage. The last fire drill was completed on March 24, 2022. Administrator certificate expires 05/22/22

· 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 one designated isolation room.

· Four (4) resident rooms, common areas, bathrooms, and outdoor physical plant was inspected.

· All resident rooms were not equipped with alcohol-based hand sanitizer but available through out 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 observed wearing masks but adhering to public health social distance guidelines.

· Sufficient supply of perishable food 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 (please see 809D for details)

Exit interview was conducted with Administrator Francis Mejia. A copy of the report was provided.