Facility Evaluation Report

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced required 1- year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met with staff member Hilaria Jimenez and Administrator Glory Callejas arrived later. LPA explained the purpose of today's Annual Inspection. LPA verified that the facility had approved mitigation and infection control plan reports. There are currently four (4), Adult Residential Care Facility (ARF) consumers in placement. The facility's annual fees are current.

The following 12 Domains will be observed and reviewed: Infection Control, Physical Plant & Environmental Safety, Operational Requirements, Staffing, Personnel Records-Training, Client Rights-Information, Food Service, Client Records-Incident Reports, Health-Related Services, Incidental Medical Services, Disaster Preparedness, and Emergency Intervention. "LPA Bunker will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections."

Staff member Hilaria Jimenez and LPA Bunker toured the facility. The facility is a single-story home located in a residential neighborhood with, a living room, dining area, kitchen, 4 bedrooms, 3 bathrooms, office, laundry room, and an indoor/outdoor activity area—a shaded area with outdoor patio furniture, table, and seating chairs. Bedrooms #1-4 are designated as the client's bedrooms.

During the tour, LPA Bunker observed sanitizer, visitor log, and thermometer at the facility entrance. Logs of daily COVID-19 screening and temperature checks of clients and staff were available and updated. PPE supplies are readily available to staff, and an additional supply of PPE was observed. Sufficient liquid soap, paper goods, cleaning, and disinfecting supplies were observed.