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 staff Mary Ann Veses and explained the purpose of the visit. Administrator Josefina Bernal arrived shortly after. There are five (5) clients level 4C developmentally disabled clients ages 59 and under. Facility is a single story home licensed for 6 ambulatory only clients. It is located in a residential area consisting of three (3) shared client bedrooms, 2 bathrooms, kitchen, dining room, living room, covered patio area, and laundry area in the attached garage. The last emergency disaster drill was completed on 2/21/2022. Administrator certificate expires 2/23/2023.

COVID-19 Infection Control Practices were observed upon entry and in common areas and LPA was screened upon entry. Two (2) caregiver staff at the facility were observed not wearing surgical masks.

Infection control signs, and other signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing.

Room #3 is designated as COVID-19 isolation room if needed.

Hand sanitizer was observed in common areas.

Clients were not observed wearing masks in the home due to cognitive impairment.

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

A Emergency Disaster Plan was posted. Please update if needed.

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

Centrally stored medication records were reviewed.

The right side of the property has discarded wood planks and the patio area is missing 2 pavers on the floor that may be tripping hazards to clients in care and staff.

Exit interview was conducted with Josefina Bernal. A copy of the report and appeal rights was issued.