Facility Evaluation Report

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required visit to the above facility. LPA was met by Merriam Imperio, Care giver and later spoke with Ceneni Rose "AU" Pare, House Manager via telephone and the purpose of today’s visit was explained.

There are currently (6) residents in the facility . (0) residents are ambulatory and (4) are non-ambulatory, (2) bedridden. The facility is a single-story structure located in a residential neighborhood. It has a ramp on the north side of the facility. It consists of (6) bedrooms, (2 1/2) bathrooms, shaded back yard, front yard, laundry room in the attached 2 car garage.

LPA and Care giver toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. INFECTIOUS CONTROL PRACTICES - LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked sanitizer/soap and paper towels in all the bathrooms and additional sanitation supplies are stored in hall closet and garage. LPA observed staff wearing masks, Residents private rooms will be converted to isolation rooms (if needed) No - trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, Fit testing completed for staff, No- Infectious Control Plan , Emergency infectious Plan posted and/or in folder, and required postings throughout the facility. Visitor designated area, resident temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPEs are enough for 30 days. All resident's and staff are vaccinated and boosted.