Facility Evaluation Report, 05/09/2022 — Apple Street, Larc Home, Newhall CA

Licensing Program Analyst (LPA) Abeye Duguma met with Bertha Chavarin for a One (1) Year Required - Infection Control visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 12:30pm and the following was noted:

There is one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, infrared thermometer, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing masks upon entrance and during the visit. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated outdoor visitors' area located in the backyard. The facility has sufficient stock of PPE in a storage closet located in the facility's office and garage. The facility has a total of four (04) bedrooms, of which one (01) is for staff, and three (03) bathrooms, of which one (01) is for staff. The facility is fire cleared for six (06) non-ambulatory clients. The facility is currently occupying four (04) non-ambulatory clients. The facility does not have a swimming pool/body of water. The garage is being used for storage. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet. Food Service/Kitchen area was sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests.

Knives and sharps are observed to be locked in a drawer inaccessible to residents. Living and dining room furniture were also checked. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 74°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguishers are located throughout the facility, observed to be full and last inspected on 09/22/2021.