Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Emerlinda Esguerra Caregiver and explained the reason for the visit.

The facility is licensed to serve (6) elderly clients ages 60 and above with a hospice waiver for (3) residents. The facility is a single story home located in a residential neighborhood and has (4) resident bedrooms, (2) bathrooms, a living room, a dining room, a kitchen equipped with a laundry area, a sun room, a detached garage, front sitting area, and a back yard.

LPA reviewed the following CARE inspection tool domains during this visit:

Infection Control: Infection control plan was reviewed which meets current regulations. Hand sanitizer and proper sanitation was observed during the visit. One staff does not have a TB test clearance on file. There is a responsible person and emergency training was provided to staff. Personal protective equipment was observed.

Operational Requirements: Facility maintains a plan of operation. Facility has a current liability insurance. Facility is operating within the license.

Physical Plant/Environmental Safety: LPA conducted a tour of the facility with Emerlinda Esguerra and observed the following: Facility was observed in good repair indoors and outdoors. Living room/dining room are clean, and providing sufficient sitting area, and lighting. Kitchen area is clean, sharps were observed locked in a drawer. Medications were observed in a drawer unlocked. Cleaning supplies were observed unlocked. Laundry area was observed in good repair. (CONTINUED ON LIC 809C)