Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted a Required Annual visit. LPA met with caregiver, Luz Yanina Cota who assisted with the tour of the facility. At 2:30pm, Administrator Hong Wei He arrived. The facility cares for elderly residents with dementia and licensed to serve 1 bedridden and 5 non-ambulatory residents. Waiver is approved to retain 1 resident on hospice. There is currently no resident on hospice. This single-story home contains six (6) bedrooms, of which one (1) is for the caregiver, three (3) bathrooms, a living room, kitchen, dining area, backyard, and storage room in the backyard. LPA observed that the facility does not have a swimming pool or other bodies of water.

The facility was toured along with caregiver Luz Yanina Cota and observed/inspected the following:

The facility had a universal entrance screening area including a thermometer, PPE supplies, screening logs, and sign-in sheet. Caregiver screened the LPA upon entry.

COVID-19 posters and signs were placed in several areas of the facility.

Facility maintained a 30-day supply of PPE located in the supply closet inside the home and in the storage room in the backyard.

Staff wore a face mask throughout her shift.

(6) Bedrooms have the required furniture such as bedframes, dressers, lamps and chairs. Beds have the required linen and the linen is in good condition.

3 bathrooms have the required grab bars in the shower and near the toilet. The bathrooms are clean and have the required hygiene items.However bathroom # 2's shower is not being used. There are boxes and supplies placed in the shower area. Bathroom #3 hot water reading in the shower is 121.3 deg. F, which is not within the required Titled 22 regulations.

***Refer to LIC 809C for the continuation of this report.