Facility Evaluation Report

Licensing Program Analysts (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with caregiver Joel Basilio assisted with the visit. The purpose for the visit was explained. The facility is licensed for residents ages 60 and over. The fire clearance is licensed to serve elderly residents age 60 and above. The fire clearance approved for two (2) ambulatory and four (4) non-ambulatory residents age 60 and above. Approved to accept or retain resident one (1) on hospice.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

1. Infection Control: The facility does not have an infection control plan in place but they continue to practice hand washing and disinfect in the facility. Facility has sufficient PPE supplies. All staff does not have any health screening and TB test result in their personnel file.

2. Operational Requirement: he facility has a dementia care plan to accept or retain residents with dementia. Currently there's one resident is on hospice and no resident is bedridden which is under the fire clearance requirement. The liability insurance was not able to review during the annual inspection.

3. Physical Plant and Environmental Safety: The facility is a single story house and located in a residential neighborhood area, the facility includes: living room, family room, dining room, kitchen, live in staff room, five residents bedrooms, three bathrooms and a detached garage. Bedroom#1 has two beds, two drawers, required beddings and furniture and sufficient lighting and closet space. Bedroom#2 to #5 has one bed, one chair, one drawer, required beddings and sufficient lighting and closet space. All the bathrooms have the required grab bar and non-skid mat. The hot water temperature tested in Bathroom#2 and bathroom were 116.4 and 118.4 which are within the Tittle 22 regulation. The hot water in Bathroom#1 is not operating. All the chemicals are stored and locked under the kitchen sink. All the appliances in the kitchen are working properly. The facility has a telephone on the premises.