Facility Evaluation Report

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced required annual visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met with Licensee Diane Sigur and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved mitigation plan report. LPA Bunker verified all current staff fingerprints cleared/associated with the facility. There are currently three (3) Westside Regional Center (WRC), Residential Care Facility for the Elderly (RCFE) consumers in placement.

The following Domain will be observed and reviewed: Infection Control Practices "I will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections."

Ms. Sigur and LPA Bunker both toured the inside and outside grounds of the facility.

The facility is a single-story family home located in a residential neighborhood. Ms. Sigur and LPA Bunker made a complete tour of the facility which consisted of a Living room, three (3) bedrooms, two (2) bathrooms, dining room, kitchen, laundry room, detached garage, shaded area, indoor/outdoor activity areas. Bedrooms #1-2 are designated as residents’ bedrooms.