Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Administrator Chona Cruz. There are currently 6 elderly Dementia residents 60 years and older residing in the facility. One (1) resident is receiving hospice care, and two (2) residents receive home health services. The inspection was completed using the CARE tools. Twelve (12) CARE tools domains were reviewed.

Visitors are still screened for COVID-19 and required to sign in. The facility has an Infection Control Plan and Covid-19 Mitigation Plan. Infection control practices and Personal Protective Equipment (PPEs) were observed.

A current Plan of Operation was reviewed.

The facility has a Dementia Waiver in place. A Hospice Waiver for 5 is approved.

A fire clearance for 6 non-ambulatory adults 60 and over is in place.

Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current and expires 6/29/2024.

A surety bond is not applicable. Facility does not handle resident's money.

***See next page for report narrative.***