Facility Evaluation Report

Licensing Program Analyst (LPA) Cynthia Chan conducted an unannounced annual visit using the Infection Control Evaluation domain. LPA met with Licensees/Administrators Amanda Palomino and Boris Palomino and explained the reason for the visit. The facility is approved for 5 non-ambulatory and 1 bedridden residents, ages 60 and over. There are currently 5 residents residing at the home.

The licensees provided a tour of the facility inside and out. The following were observed/inspected:

· Upon entry, temperature was taken and recorded on a log.

· The facility has 3 bedrooms, 3 bathrooms, living room, kitchen, dining room, family room, laundry area, and an attached garage. Each bedroom is equipped with the required furnishings.

· Bathrooms have soap, paper towels, and trash bins with lids.

· There are no items obstructing the entry or walkway.

· Signage for Covid-19 are posted around the facility to promote hand hygiene and cough etiquette.

· A pool is located in the backyard, surrounded by a 6 foot fence and is locked.

· Staff at facility were all wearing face coverings and were assisting residents with their activities.

· Knives and disinfectants were all stored and locked, inaccessible to residents.

· Medications were reviewed for all 5 residents and are being administered as prescribed by the physicians.

· Sufficient food supplies of 2-day perishable and a week of non-perishable are observed.

· The hot water temperature was measured at 117.7 degree F, which is within the required range of 105 – 120 degree F.

There are no deficiencies observed during today’s visit. A copy of this report along with the appeal rights were given to the Licensee.