Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspection. LPA was allowed entry by Brisia Rojas, Caregiver and explained the purpose of today's visit. Administrators Andrei Kohler and Yelly Kohler greeted LPA shortly after and assisted with the inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor screening station at the entrance of the facility. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan and was reviewed. Facility has COVID-19 signage posted in the facility. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements.

Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. A fire clearance is in place. Liability Insurance policy (policy # 000937293) in the amount of $1,000,000.00 each occurrence and #3,000,000.00 in the total annual aggregate is valid and will expire on 6/23/2023. The last fire Drill was conducted on 03/05/2023. Care and supervision to meet the residents needs was observed. Special equipment and supplies to meet the persons with special needs were observed.

Physical Plant/Environment Safety: he facility is a single story home located in a residential neighborhood that is licensed to serve 6 non-ambulatory residents ages 60 and over, may retain 4 hospice residents. Current census is six (6) non ambulatory of which three (3) are under hospice care. Home consists of four (4) resident bedrooms, 2 bathrooms (1 full and 1 1/2), living room, dining room, medication/TV room, kitchen, backyard, and a detached garage being used as a private residence for the Administrators, Andrei and Yelly Kohler. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors are operational. The facility has (3) fire extinguishers in the facility. One (1) fire extinguisher located in the kitchen was purchased on 6/20/2022. The other (2) fire extinguishers were purchased on 5/20/2022 and the Administrator stated that they will purchase new ones. LPA reviewed the fire inspection report conducted and completed by Pasadena Fire Dept. on 4/30/2023. Cleaning supplies and toxic substances are inaccessible to clients. At 10:50am, hot water temperature readings measured 116.2 deg F in the kitchen, 115.9 deg F in bathroom #1 and 109.5 deg F in bathroom #2 which are within the required 105-120 degrees Fahrenheit.