Facility Evaluation Report

Licensing Program Analysts (LPAs) Gary Tan and Michael Cava met with Administrator Itzel Guevarra and Office Manager Adriana Cisneros for a One (1) Year Required visit for this facility. LPAs explained the reason for the visit. This facility is fire cleared for sixty (60) non-ambulatory residents, ten (10) of which may be bedridden. Hospice waiver for six (6) residents.

A tour of the physical plant was conducted at 11:15 AM and the following was noted:

There is only one entrance being utilized at the facility, the front main entrance door. There are required poster posted at the main door. Screening area is located immediately upon entrance. There is also a sign in sheet, hand sanitizer, gloves and masks available. The facility had submitted and approved Mitigation and Infection plan.

There are hand sanitizing stations all over the facility. There are signs for Covid 19 prevention protocol were posted inside. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in common bathrooms and all over the common areas of the facility. The facility have designated visitors' area at the front yard. The facility has sufficient stock of PPE in the office upstairs.

The facility is a two (2) storey building with shared and private bedrooms and bathrooms. Second floor is used only as an office/storage for staff use only. All indoor and outdoor passageways/exits were free of obstruction. There is no body of water in the facility. The facility maintains a comfortable temperature at 75°F. The facility's smoke alarms are hard wired and tested regularly every month. Fire inspection was last done on 08/14/23 and valid until 05/31/26. The facility is also equipped with sprinkler system which was last tested on April 2023 and valid for five (5) years. Fire extinguishers are located all throughout the facility and were last serviced on 10/12/23. Fire Drill was last conducted on 07/08/24. (continued to LIC 809-C)