Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection with the focus of the infection control domain. LPA was allowed entry by staff, Ria Tabucal, and stated the purpose of the visit. Administrator, Glorie Pascasio, arrived shortly thereafter to assist with the visit. The facility is licensed for 4 ambulatory adults ages 18 through 59. There are currently 4 ambulatory clients residing at the home.

LPA Chan toured the facility inside and out. The facility has 4 bedrooms, 2 bathrooms, living room, dining area, kitchen, and attached garage. There are no pool or bodies of water on the premises nor items obstructing the walkways. LPA observed proper signage posted throughout the home. The facility keeps a log documenting the daily temperature and symptoms check of staff, clients, and visitors. Each client is able to quarantine in his/her own room. There are at least 30 days of PPE supplies such as N95 masks, gloves, gowns, and hand sanitizers, stored in the garage. LPA observed at least 2 days of perishables and a week of non-perishable food items. The hot water temperature was measured between 105-120 degrees Fahrenheit. The medications were reviewed for 4 clients and they are being administered as prescribed by the physician. The clients have updated contact information on file. The fire extinguishers were last inspected on 10/27/2022. Per the Administrator, she has backup staff to assist clients when needed. The facility is continuing to follow their mitigation plan and the strictest guidance. They are still conducting COVID-19 testing on a weekly basis for all clients and staff.

There are no deficiencies observed during the visit today.

An exit interview was conducted and a copy of this report was given to Staff R. Tabucal.