Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted continued unannounced Annual Required Visit on 12/15/2023. LPA was met by Staff Cory Dominguez and Monica Aguilera arrived a short time later and assisted with the visit. LPA explained the purpose of the visit. Facility is licensed to serve 6 residents over 60 years old. The facility cares for elderly residents and has hospice waiver for 6 residents. LPA Lopez requested copies of Personnel Report and Resident Roster (LIC 9020)

LPA did not utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today due to technical issues. Below are the domains that LPA inspected:

1, Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting the clients. Staff are cleaning and disinfecting each shift for high touched surface area. Facility has sufficient PPE supplies and has an Infection Control Plan.

2. Physical Plant and Environmental: The facility is a single-story house and located around a residential neighborhood area. The facility includes living room, dining area, kitchen, six clients bedrooms, two private bathrooms and 2 common bathrooms, laundry area and for storage for medications. LPA inspected the carbon monoxide detector and is working probably. The smoke detectors are in each room and common area, and they are operable. LPA tested the hot water temperature, and it tested between 108.3 - 111.3 degrees F. which are within the Title 22 regulations. All the sharp knives and utensils are locked under the kitchen sink. All the cleaning supplies and chemicals are locked in the detached garage. The facility has sufficient personal hygiene products for clients to use. All clients rooms are furnished and have required beddings. All the bathrooms are clean, sanitized, and operational. The exit and passageway are safe and free of obstruction.