Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted an announced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA was met by Dsp Gertrude Armamento and explained the purpose of the visit. Administrator Giovani Angeles arrived a short time later and LPA discussed purpose of visit. Facility is an Adult Residential facility. Home is level 4 home. The facility consists of 4 client rooms, 1staff room, (3) restrooms, kitchen and dining room, and 2 living rooms. Water was measured between 105.8 -106.0 degrees, toilets and showers observed operable.

The last fire drill was completed on April 24, 2022 Administrator certificate expires June 21, 2022.

· 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 designated isolation room.

Five (5) rooms, common areas, bathrooms, and outdoor physical plant was inspected.

· Four (4) centrally stored client medication records were reviewed.

· Staff responsible for direct care and supervision were observed wearing masks.

· Clients were not wearing mask at time of visit but adhering to social distancing guidelines.

· Sufficient supply of non-perishable foods for 7 days was observed.

· A posted Emergency Disaster Plan was not observed.

· Staff and resident files were not reviewed during today's visit.

· Deficiencies cited (see 809D for details)

Exit interview was conducted with Administrator Giovani Angeles. A copy of the report was provided.