Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Maria Luisa DelRosario and explained the purpose of the visit. Administrator Lilibeth Esguerra-Nuckolls arrived shortly after. The facility is a single story home located in a residential neighborhood. It is licensed for 6 level 4A non-ambulatory clients. It consists of 3 client bedrooms, 1 staff bedroom, 2 bathrooms, dining room, kitchen, living room, backyard, and detached garage. Administrator certificate expires June 25, 2023.

COVID-19 Infection Control signs were observed in the entrance/bathrooms, and was screened.

Bedroom #2 is designated as the COVID-19 isolation room if needed.

Three (3) centrally stored resident medication record was reviewed. Facility maintains a 30-day supply of medications. Centrally stored medications are kept in a locked cabinet.

Client in care does not wear a mask because it is not tolerated due to cognitive impairment.

Chemicals/cleaning supplies are stored inaccessible to residents.

Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.

A posted Emergency Disaster Plan was observed.

Smoke detectors were tested and are operational. Fire extinguisher is fully charged.

Sufficient supply of Personal Protective Equipment (PPEs) was observed.

Staff and resident files were not reviewed during today's visit.

Outdoor and indoor passageways and exit doors are free of debris and obstruction.

Kitchen knives/sharps were observed unlocked underneath the kitchen sink.

The last emergency disaster drill was conducted on 12/15/2021. Emergency disaster drills must be conducted every 6 months.

NOTE: Infection Control Plan was due June 30, 2022. It has not been submitted to CCL.

Exit interview was conducted with Administrator Lilibeth Esguerra-Nuckolls. A copy of the report/appeal rights was issued.