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 Ron Wilbert who called the administrator Jessica Hernandez and explained the reason for the visit. The administrator designated Mr. Wilbert 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 12:48 PM. 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 facility is fire cleared for four (4) non-ambulatory residents.

The front main door is the only entrance being utilized at the facility. 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 indoors. 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 105. 6°F to 109. 6°F . (continued on LIC 809-C)