Facility Evaluation Report

Licensing Program Analysts (LPAs) Cynthia Chan and Kimberly Ramirez conducted the unannounced annual inspection with the focus of the infection control domain. LPAs met with Wellness Director, Ruby Racca-Magao, who assisted with the visit. The facility is licensed for 85 non-ambulatory residents, age 60 and over, of which 9 may be bedridden. The hospice waiver is approved for 20 residents.

LPAs toured the facility and observed the following:

* The building consists of 5 floors. The first through fourth floors consist of residents rooms and the fifth floor is the dining area. The common areas are located on the first and third floor.

* Covid-19 signage are posted throughout the facility. Hand washing signs are posted in the bathrooms.

* Extra PPE supplies of at least 30 days are observed.

* The facility has a digital Covid-19 screening form for all staff and visitors.

* LPAs inspected rooms #107, #117, #212, #215, #308, #314, #404, and #405. The rooms are clean and have the required furnishings.

* Food supplies of 2 day perishable and a week of non-perishable are observed.

* Medications are centrally stored in the Wellness Office. LPAs reviewed 4 residents' medications and medications are being administered as prescribed. These 4 residents' files also have updated emergency contact information forms.

* 3 Staff and 4 Residents were interviewed.

* Staff were observed wearing a face mask.

* Staff are cleaning and disinfecting on each shift and more often for high touched surfaces.

* Per the Wellness Director, they have backup staff when needed and are following the strictest covid-19 guidance.

There are no deficiencies issued today. The exit interview was held. A copy of this report was given to the Administrator.