Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspection. LPA was allowed entry by Victoria Mejia, Caregiver and explained the purpose of today's visit. Administrators Nvard Gevorkian and Diana Castellanos arrived shortly after and assisted LPA with the inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor screening station at the entrance of the facility. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan and was reviewed. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood that is licensed to serve 6 non-ambulatory residents ages 60 and over, of which (1) may be bedridden. Waiver granted for (2) hospice care. Current census is six (6) of which one (1) is under hospice care. Home consists of six (6)resident bedrooms, 2 bathrooms, living room, dining room, kitchen, backyard, and a detached garage being used as a staff rest area. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors are operational. The facility has (2) fire extinguishers in the facility which were last serviced on 10/08/2024. There are cameras in the common areas. Cleaning supplies and toxic substances are inaccessible to clients. At 10:20am, hot water temperature readings measured 116.9 deg F in bathroom #1 and 109.2 deg F in bathroom #2 which are within the required 105-120 degrees Fahrenheit.

Operational Requirements : Infection Control and Dementia plans have been added to the Plan of Operation. A fire clearance is in place. Liability Insurance policy is valid and will expire on 05/17/2025. The last fire Drill was conducted on 09/17/20243. Care and supervision to meet the residents needs was observed. Special equipment and supplies to meet the persons with special needs were observed. ***CONTINUED ON LIC 809-C**