Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Administrator Ana Santos and explained the purpose of the visit. There are 3 residents ages 60 and above. The facility has a Dementia waiver and a hospice waiver for 2 residents. The facility has one (1) hospice resident in place. It is a owner operated single story home located in a residential neighborhood that is licensed for 2 non- ambulatory and 2 bedridden residents.

LPA conducted an exterior and interior physical plant tour. The home consists of 5 bedrooms; 3 for residents [2 private & 1 shared) and 2 staff bedrooms for live-in staff, living room, dining room, kitchen, outdoor covered patio area, laundry room, and a 3 car detached garage in the rear of the property presently being used as storage area. The last emergency disaster drill was conducted on 3.22.2023. Administrator certificate expires 3/26/2024.

The following was inspected and observed during the inspection:

COVID-19 infection control signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Facility has an approved COVID-19 mitigation plan. LPA was screened upon entry by staff.

Each resident room is designated as the COVID-19 isolation room if needed.

Due to cognitive impairment residents in care do not wear masks.

Three (3) centrally stored resident medication records were reviewed. Facility maintains a 30-day supply of medications. Centrally stored medications are kept in a locked closet.

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

Resident (R1's) file was reviewed. No physician order was on file for bed half rails.

A posted Emergency Disaster Plan was observed.

Sufficient supply of Personal Protective Equipment (PPEs) was observed.

Exit interview was conducted with Ana Santos . A copy of the report and appeal rights were issued.