Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. LPA arrived at the facility and rang the doorbell, but no one answered. LPA called the facility and spoke with Patricia Wong who contacted another staff who will be coming to the facility to assist. At 10:04am, Marta Ramos, Asst. Wellness Coordinator arrived but had the wrong keys and could not open the door. At 10:20am, Wendy Vasquez, DSP Supervisor arrived to let LPA in and explained the purpose of the visit. At 10:45am, Hector Vargas arrived and assisted with the inspection. The facility is licensed to care for (6) non ambulatory residents age 60 and over. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Bathroom has hygiene items such as paper towel, hand soap and t oilet paper.

Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. A fire clearance is in p lace. Liability Insurance policy is valid and will expire on 07/15/2025. Surety Bond Insurance with bond amount of $3750 is valid and will expire on 02/28/2025. Last Fire Drill was conducted on 10/22/2024 and according to the Administrator, emergency drills are conducted on a quarterly basis.

Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (3) resident bedrooms, (3) bathrooms, living room with fireplace, kitchen, dining area, laundry/storage area, side yard and backyard. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, linen, light, chair and sufficient closet space. LPA observed that the coating on the bathtub in bathroom #1 was chipping and worn out. Side yard and backyard were inspected and have a shaded and sitting area. There are (2) fire extinguishers in the facility which was last serviced on 04/24/2024. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit. Water readings were 112.2 deg. F in bathroom #1, 109.5 deg F in bathroom #2 and 110.6 deg F in bathroom #3.