Facility Evaluation Report

Licensing Program Analysts (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 Licensee Percy Olidan. The following 12 (CARE) tool domains were utilized during the inspection:

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

(2) Living rooms, kitchen, dining area, (6) bedrooms of which (3) are for resident use, (4) bathrooms, (1) office, outdoor kitchen/laundry area and a detached storage room.

The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are enclosed ponds in the backyard. Cleaning supplies and toxic substances are inaccessible.

Water temperature readings measured within title 22 regulations.

A current Plan of Operation observed. Dementia Care Plan Observed

A fire clearance for 6 residents of which (6) may be non ambulatory

Hospice care waiver approved for up to one (1) resident.

Facility does not have an active liability insurance.

Administrator on file is not current and administrator certificate for licensee and current administrator is currently expired.

Two (2) staff files were reviewed. Required documents observed for files reviewed.