Facility Evaluation Report

An unannounced Required One (1) year visit was conducted on this day by Licensing Program Analyst (LPA) Gary Tan. LPA met staff Jessica Hernandez who called the administrator Jessica Willoughby and explained the reason for the visit. The administrator designated Ms. Hernandez to sign the report. This is a North Los Angeles Regional Center vendored facility Level III.

LPA conducted physical plant tour inside and out at 9:48 AM. During the tour, LPA observed that the facility has four (4) bedrooms and two(2) bathrooms. There is no body of water in the facility.

The front main door is the only entrance being utilized at the facility. There is a sign on the front door that everyone entering at the facility must be screened. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available.

The facility had submitted and approved Mitigation and Infection Plan.

Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. 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. There are enough linens in stock in the cabinet.

Bathrooms were observed to be clean, sanitary and with necessary supplies. Hot water temperature measured at a range of 115. 2°F to 119. 5°F . (continued on LIC 809-C)