Facility Evaluation Report

Licensing Program Analyst Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Caregivers Charlene Borla and Kimlan Suhalim who assisted with the visit, the Administrator Ma Flora DeGuzman assisted with the visit in the early am but had to leave for a scheduled training, returned later for the exit interview. The purpose for the visit was explained. The facility is licensed to serve 3 ambulatory and 1 non-ambulatory clients ages 18 to 59 years old, and a hospice waiver for one client. The facility is in a residential area. A tour of the single-story facility included the living room, dining area, kitchen, laundry room, 4 client bedrooms, 1 staff bedroom, 2 client bathrooms, 1 staff bathroom, attached garage, front yard, and backyard. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents’ medications. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan posted in the living room.

Operational Requirements: There are currently 4 ambulatory residents residing at the facility. The facility has the sufficient amount for liability insurance covering injury to residents and guest.

Physical Plant & Environment Safety: There are 5 bedrooms, 3 bathrooms, living room, dining room, kitchen, and an attached garage. Facility has operable smoke and carbon monoxide combo detectors located in each room and hallway. Knives, cleaning solutions, and disinfectants are locked in the cabinets. No firearms or weapons are stored at the facility. Clean towels and extra linen were observed in a hallway closet. LPA measured the hot water temperature in the bathrooms and kitchen sink. The hot water temperature in the bathroom and kitchen were measured between 108.0-112.6 degrees F which are within the required range of 105-120 degrees. All bedrooms have all required furniture, lighting, and bedding. Passageways are free of obstruction and debris. The front and back yard are maintained well and there's a shaded area the back patio for resident to utilize.