Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to staff Cynthia Tadeo. The following domains were completed:

Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. An Infection Control Plan was observed

The facility is located in a residential neighborhood. The facility includes a staff office, laundry room, dining area, common area/TV room, staff bathroom, (6) residents bedrooms and (6) resident bathrooms and a detached garage. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. There are no bodies of water in the facility.

Water temperature readings measured within title 22 regulations.

A current Plan of Operation was observed.

Fire clearance approved for (9) residents with age range 60 and over. Clearance is approved for up to (9) Non-ambulatory and has an approved hospice waiver for up to five (5) residents.

Facility has an active liability insurance. Copy was collected and reviewed

Administrator on file is current. Administrator certificate is currently active

Four (4) staff files were reviewed. Required documents observed for files reviewed.