Facility Evaluation Report

Licensing Program Analyst (LPA) Lopez conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA was greeted by Ana Gasper and explained the purpose of the visit. Administrator Monica Aguilera-Perez arrived shortly after. There are 5 residents 60 and older. The facility has an approved fire clearance for six (6) non-ambulatory residents and zero (0) ambulatory / bedridden resident. The facility is a single-story home with six (6) client’s bedrooms, four (4) bathrooms, a kitchen, a dining room, a living room, a detached garage, a backyard and a front yard located in a residential neighborhood. This facility was granted a fire clearance on 11/12/19. The last fire drill was completed on December 13, 2021. Administrator certificate expires September 9, 2022.

· COVID-19 signs are posted at the entrance. Visitors are screened in the main entrance and a log is kept.

· Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen, and hallway to promote handwashing, cough/sneeze etiquette, and physical distancing.

· Facility has ability to designated isolation room since all residents have their own room.

· Six (6) client rooms, common areas, bathrooms, and outdoor physical plant was inspected.

· Facility is equipped with alcohol-based hand sanitizer.

· Four (4) centrally stored client medication records were reviewed.

· Staff responsible for direct care and supervision were observed wearing masks and face shields and gloves.

· Clients were not observed wearing masks but adhering to public health social distance guidelines.

· Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.

· An Emergency Disaster Plan was observed.

· Staff and resident files were not reviewed during today's visit.

· Deficiencies were noted on todays visit, per Title 22 Division 6 Chapter 6. Appeals Rights discussed & a copy given during visit. (See 809D)

· Exit interview was conducted with Assistant Administrator Monica Aguilera-Perez. A copy of the report was provided.