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. LPA met with staff Lara and the purpose of the visit was discussed. Administrator Anthony Ngo arrived shortly after.

1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. LPA observed and reviewed the infection control plan

2. Physical Plant/Environmental Safety: LPA toured the facility inside and out to ensure there are no health and safety hazards. The facility is located in a residential area. A tour of the single-story facility includes: Living room, family room, attached garage/laundry area, dining area, kitchen, 3 resident bedrooms, 1 staff bedroom and 2 bathrooms. Each residents' bathrooms are clean, sanitary and in a operable condition. LPA tested hot water temperatures and they were between 105 and 120 degrees F. which are within Title 22 regulation. LPA also inspected the smoke detectors and carbon monoxide detectors and they are all working well. Each residents room have the required furniture, bedding and sufficient lighting and closet space. The facility have a telephone services in the premises.

3.Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. Facility has a fire clearance for (6) total capacity of which (2) may be non-ambulatory. Liability Insurance reviewed and matches Licensing requirements.

4. Staffing: Sufficient staffing was observed during the visit. There is NOC shift staff scheduled for each day.

5. Personnel Record/Training's : The Administrator Anthony Ngo and administrator certificate is currently pending review for renewal. All the facility staff have criminal background clearance and associated with the facility and the required training. Four (4) staff files were reviewed. Required documents were observed.