Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Ofelia Tanglao and explained the purpose for today’s visit. The facility is licensed to serve 6 Residents ages 60 and above, (4) of which may be non-ambulatory in rooms 1 & 3 only, there is a hospice wavier for 2 . The facility currently has 4 residents, (1) of which is using hospice services.

The facility is a single-story home located in Norwalk, Ca. A tour of the facility includes: 5 Resident bedrooms, 3 bathrooms (1 bath is within a private room), 2 dining areas, 2 kitchens, 2 living rooms, laundry area, front yard, back yard and attached garage.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following:

Infection Control: Facility has sufficient PPE supplies and the required Infection Control Plan.

Operational Requirements: Administrator was not able to provide LPA with a copy of the required valid liability insurance, and the facility is operating outside of what they are licensed for and what their fire clearance has approved as there is 1 bedridden resident in the facility, citations will be issued in detail on the LIC809-D page. Civil Penalties will be issued on the ambulatory status for having 1 bedridden resident.

Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested throughout the facility and measured within the required range of 105-120 degrees F. LPA observed cleaning solutions, and a knife stored in an unlocked cabinet during tour, citation will be issued in detail on the LIC809-D page. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged.