Facility Evaluation Report

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on infection control, medication, and food review. LPA met with Ruby Garcia Administrator and explained the reason for the visit.

The facility is licensed to serve 136 ambulatory clients ages 18-59 years old with an approved hospice waiver for 5 residents. Facility is a two story building located in a residential area, with a commercial kitchen, a patio, a medication/office room in the first floor, an activity and TV room in the second floor.

LPA conducted a tour of the facility with Ruby Garcia - Administrator and observed the following:

LPA Flores observed 10 randomly chosen client rooms #105,109,123,126,132,201,205,209,220,225. Each room has sufficient furniture, bedding, and lighting, room's bathrooms were observed in working condition and water temperature was tested between 98.3 to 119.8 degrees F. which is not within the required 105-120 degrees F. Bathroom in room #105 had a broken window on the lower left side of about 3 inches in length and 2 inches in width, An unattended housekeeper cart with accessible cleaning supplies was observed in room #109 and the bathroom had a hole in the ceiling over the shower of about 12 inches by 6 inches. Facility has a fire sprinkler system throughout. Fire extinguishers were observed throughout the facility and kitchen and last checked on July 2022. Commercial kitchen was observed operable and sufficient food for at least 2 days of perishables and 7 days of non-perishable supplies were observed. No large bodies of water were observed. Medication was observed to be centrally stored in medication room and medication for 10 clients were reviewed.

LPA observed signs throughout the facility for hand-washing, cough/sneeze etiquette, and symptoms. Screening and visitor log was conducted. Infection control is observed by staff regarding cleaning, testing, and practices. PPE supplies were observed for at least 30 days. Staff have not been fit test for N95.

Deficiencies were noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Ruby Garcia - Administrator and a copy of this report, LIC 809D, technical advisory and appeal rights was provided,