Facility Evaluation Report

An unannounced Required One (1) year visit was conducted on this day by Licensing Program Analyst (LPA) Jose Tan. LPA met with Administrator Licensee Representative Jean Sevilla . Purpose of the visit is stated. This is a North Los Angeles Regional Center vendored facility Level II.

LPA conducted physical plant tour inside and out at 12:43 PM. During the tour, LPA observed that the facility has four (4) bedrooms and three (3) bathrooms. One (1) bedroom and one (1) bathroom is designated for staff use. There is no body of water in the facility.

The front main door is the only entrance being utilized at the facility. The facility had submitted and approved Mitigation and Infection Plan. All trash cans were observed to be with cover. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage.

Bedrooms were toured and observed to be clean and appropriately furnished.

Bathrooms were observed to be clean, sanitary and with necessary supplies. Hot water temperature measured at a range of 106. 9°F to 110. 7°F .

Physical plant was checked for cleanliness and condition. Facility was observed to be in good repair and clean during today's visit.

Living and dining room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition.

Temperature of facility wall thermostat was set at 72.0 °F and observed to be within the required range.