Facility Evaluation Report

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Required- 1-year visit focusing on COVID-19 Infection Control Practices. LPA was greeted by Sarina Roby Caregiver and Administrator Segundino Gotladera arrived short time later. LPA explained the purpose of the visit. Administrator Certificate expires 09/04/2023 fire drill was on 03/01/2022

Facility is a single story home and it is licensed to served 6 ambulatory clients between the ages of 18 to 59 years old. Facility has no fences or bodies of water. LPA observed 4 client bedrooms; Bedrooms have all furniture, lighting, and bedding required. 2 client bathrooms; bathrooms had soap, and paper towels available. The passageway and walkways are free of hazard and free from obstruction.

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

· Water temperature measured between 105 – 120 degrees F which is within regulation range.

· 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 does has one designated isolation room.

· Four client rooms, common areas, bathrooms, and outdoor physical plant was inspected.

· Four client rooms were equipped with alcohol-based hand sanitizer.

· Five (5) centrally stored client medication records were reviewed.

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

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

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

· A posted Emergency Disaster Plan was observed posted at facility.

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

· Deficiencies were observed during today’s visit. (see 809D)

· Exit interview was conducted with Administrator Segundino Gotladera.. A copy of the report was provided.