Facility Evaluation Report

A Required One (1) year - Infection Control visit was conducted today by Licensing Program Analyst (LPA) Gary Tan. LPA met with Assistant Administrator Clyde Acabal. Purpose of visit was stated. LPA observed that five (5) residents were at the facility during visit, the other one (1) is attending a day program. This facility is vendored by Regional Center as a level 4C.

A tour of the physical plant was conducted at 10:04 AM and the following were noted:

The main door is the only entrance being utilized for entry. There is a sign on the door that everyone entering at the facility must wear mask and must be screened. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened by the staff upon entry. All staff were observed to be wearing mask.

The facility had submitted and approved Mitigation plan.

Signs to wear a mask and other Covid 19 prevention protocol signs were posted on the walls. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to be with cover.

The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room.

The facility has six (6) bedrooms and four (4) bathrooms currently occupying six (6) residents on two (2) private rooms and two (2) shared rooms. The two (2) bedrooms are designated for the staff. The facility is licensed to care for clients with dementia and developmentally disabled elderly (continued on LIC 809-C)