Facility Evaluation Report

A Required One (1) year visit was conducted today by Licensing Program Analyst (LPA) Gary Tan. LPA initially met with Assistant Administrator Richard Denogean. Administrator Lanny Wonoprobowo arrived later. Purpose of visit was stated. LPA observed that all four (4) residents were at the facility during visit. This facility is North Los Angeles Regional Center vendored facility Level IV-G (Medical)

A tour of the physical plant was conducted at 12:48 PM and the following was noted:

The only entrance being utilized is the main front door, there is a sign at the main door that everyone entering at the facility must wear mask. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available.

The facility had submitted and approved Mitigation and Infection Control Plan.

Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to be with cover.

The facility has a designated visitors' area at the backyard by the pool. The facility has sufficient stock of PPE in the storage room.

Facility has four (4) bedrooms and two (2) bathrooms and one (1) toilet. Two (2) bedrooms are designated for staff use and one (1) bathroom and one (1) toilet is designated for staff use. There is an office adjacent to the living room. The facility is fire cleared for four (4) non-ambulatory residents.