Facility Evaluation Report

A Required One (1) year visit was conducted today by Licensing Program Analyst (LPA) Jose Tan. LPA met with Administrator Lanny Wonoprabowo. Purpose of visit was stated. LPA observed that all the residents were at the facility during visit. This facility is North Los Angeles County Regional Center vendored facility Level IV-G (Medical).

A tour of the physical plant was conducted at 9:02 AM and the following was noted:

The only entrance being utilized is the main front door. The facility had submitted and approved Mitigation and Infection Control Plan. 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.

Bedrooms were toured and observed to be clean and properly furnished. Linen storage was also checked and observed to have ample supply of clean linen and towels.

Bathrooms were observed to be clean and sanitary with necessary supplies. Hot water temperature measured at 108.3°F and within the required range.