Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual required 1-year visit. . LPA was met by Evangelina Reyes, Co-Administrator and Administrator Amanda Palomino arrived a short time later and also assisted with the visit. LPA explained the purpose of the visit. The facility is licensed to serve six (6) residents over the age of 60, of which six (6) may be non-ambulatory and has a hospice waiver approved for four (4). One (1) out of the six (6) residents in care is currently on hospice care.

1. Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting the clients. Staff are cleaning and disinfecting each shift for high touched surface area. Facility has sufficient PPE supplies and but does have an Infection Control Plan.

Physical Plant: The facility is a single-story dwelling located in a residential neighborhood and consists of three (3) resident bedrooms, one (1) staff bedroom, two (2) shared bathrooms, kitchen, dining room, living room, detached garage, front yard, and backyard. LPA Lopez observed auditory device on entry of door to be operational, sliding door and exits.

LPA Lopez observed knives and sharps located in kitchen cabinet, to be inaccessible to residents in care. Kitchen appliances were observed to be clean and in working order. LPA observed staff preparing lunch for residents during visit. Monitor was observed to be mounted near sink area and accessible to residents, staff, and visitors. Water temperature in two (2) resident bathrooms was within 107.1 -107.4 degrees F. which is within range. Bathrooms were observed to be very clean and well stocked. LPA observed signs promoting proper hand-washing etiquette. ( See 809-C for continuation).