Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos made and unannounced Annual inspection focused on Infection Control. On today’s visit LPA met with Administrator Gina Baluyot . The purpose of the visit was discussed.

As a part of the inspection, LPA used the inspection tool, reviewed (3) resident records, (2) staff files, and (3) resident medications. Currently the facility has (3) clients which (2) are ambulatory and (1) is non-ambulatory. Facility is a one story family home with four (4) bedrooms, two (2) bathrooms, living room, kitchen, central air and heating, dining area, laundry room, a shaded area located in the backyard. an attached garage inaccessible to residents. Front and back yard is in good condition at time of visit. Washer/Dryer appliances observed. Toxins and sharps locked and inaccessible to clients. Bedrooms #1-#3 had required furnishing. Bedroom#4 is for live in staff. Bathrooms have a working toilet, wash basin, and shower. Beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads. Supply of hygiene supplies were observed. Fire alarms are interconnected and operational. Required postings observed. Water temperature within required tittle 22 regulations.

Infection control domain completed and there were no deficiencies. An exit interview was conducted with Administrator Gina Baluyot