Facility Evaluation Report

Licensing Program Analysts (LPAs) Daniel Konishi and Christine Wong, conducted a required unannounced annual inspection using the Inspection Tool. LPA met with Staff#1 (S1), Eadgitha Manalad and the purpose of the visit was discussed. S1 assisted in the tour of the facility.

The following (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Resident Rights/Information, and Food Service.

· Infection control practices and Personal Protective Equipment (PPEs) were observed. LPA observed that the facility has no infection control plan in place.

· LPA conducted a tour of the facility with S1, staff and observed the following:

The facility is part of a single-story home located in a residential area and contains the following: living room, TV room, dining room, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, (4) resident rooms, (2) bathroom for residents, toilet and washbasin. A back yard with shaded area and seating for resident use. There’s a laundry area; with washer and dryer.

· All passageways, walkways, driveway, steps and patio are free from obstructions. The front, back and side areas of the house are free of hazards.

· Hallway linen closet: Contained plenty of linens, towels, and hygiene products.

· Beds have the required furniture including bedframes, night stands, dressers, lamps, and chairs. Beds have the required linen and the linen is in good condition.