Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspection. LPA was allowed entry by Violeta Necesito (Caregiver) and Jorgen Deleon (Caregiver) and explained the purpose of today's visit. Administrator, Irene Deanon arrived at 10:30am and assisted LPA with the inspection.

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

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor screening station at the entrance of the facility. The facility has submitted a COVID-19 Mitigation Plan and was reviewed. Facility has not developed and submitted the infection control plan to CCLD. Administrator agreed to develop and submit the Infection Control Plan to CCL. Facility has COVID-19 signage posted in the facility. Common area surfaces are being cleaned and disinfected on a regular basis. Staff are adhering to infection control requirements.

Operational Requirements : Administrator cannot find and provide the plan of operation to LPA for review. Liability Insurance policy (policy # 00105792-3) in the amount of $1,000,000.00 each occurrence and #3,000,000.00 in the total annual aggregate is valid and will expire on 7/29/2024. There was no proof of Fire and Disaster Drill which was to be conducted on a quarterly basis. Care and supervision to meet the residents needs was observed. Special equipment and supplies to meet the persons with special needs were observed.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood that is licensed to serve 6 non-ambulatory residents ages 60 and over, of which six (6) may be bedridden. Hospice waiver for 6 was approved. Current census is five (5) non ambulatory, one (1) ambulatory, two (2) are under hospice care and one (1) is bedridden. Home consists of five (5) resident bedrooms, one (1) office room, three (3) bathrooms, living room, dining room, staff lounge area, kitchen, backyard, and a detached garage. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors are operational. The facility has two (2) fire extinguishers which were last inspected on 5/04/2023. Cleaning supplies and toxic substances are inaccessible to residents. At 10:05am, hot water temperature readings measured 113.9 deg F in bathroom #1, 114.9 deg F in bathroom #2 and 116.4 in bathroom #3 which are within the required 105-120 degrees Fahrenheit. ***CONTINUED ON LIC 809-C**