Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with administrator Joy Villaflores and the purpose of the visit was explained.

The following CARE tools domains were utilized during the inspection.

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. Visitors are no longer screened for COVID-19 or required to sign in. The facility has an Infection Control Plan and COVID-19 Mitigation Plan.

Physical Plant/Environment Safety: The facility is a single-story house located in a residential neighborhood. Facility has three resident rooms; room #2 #3 and #5. Resident room #5 contains a private bathroom, three staff rooms; room #1, #4 and #6. Room #4 contains a private restroom for staff. There is (1) common bathroom for all residents to use. Total bathrooms is (3). Facility has a dining room, a kitchen, a front and back yard patio area which held a storage shed and the facility’s washing and drying machines, and an attached garage which held the facility’s emergency food supply and cleaning supplies. 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. Water temperatures measured within Title 22 requirements. The facility has one (1) fully charged fire extinguisher.

Operational Requirements: The facility has a Dementia Waiver on file. A Hospice Waiver for up to (1) Resident is approved. Facility as an approved fire clearance to serve total of six (6) residents age 60+ of which four (4) may be non-ambulatory. Required Liability Insurance is in place. A surety bond is not applicable. Facility does not handle resident's money.