Facility Evaluation Report

Licensing Program Analyst (LPA) Shira Stamps met with Administrator Cecilia and Felix Campos for an unannounced one (1) year Required visit for this facility.

LPA arrived at 9:45am and was greeted by caregiver Michael Villanueva. One (1) resident was observed in the living room watching TV. The rest of the residents were observed to be in their rooms watching TV and/or resting. Administrator Cecilia and Felix Campos arrived at 10:00am. LPA informed the Administrator of the purpose of the visit.

Infection control: LPA reviewed facility mitigation plan (approved on 03/06/21) to make sure licensee was following current infection control recommendations. Upon arrival LPA was screened by the caregiver and asked all infection control questions. LPA was asked to sign-in and sanitize/wash hands.

A tour of the physical plant was conducted with Administrator at 10:01am. The facility has three (3) bedrooms and two (2) bathrooms currently occupying six (6) residents. One (1) bathroom is designated for staff use only or over flow for the residents in an emergency, and the facility has awake staff at night. The facility is Fire Cleared for six (6) ambulatory.

LPA observed rooms to have the appropriate bedding. There is a night stand and sufficient lighting for each resident.

At 10:16am LPA observed all bathrooms to have non-skid matts, and the appropriated wash your hands signs posted. Hot water was tested at 10:16am and measured within regulation at 116.8 degrees F.