Facility Evaluation Report

Licensing Program Analyst (LPA) Wong and Nurse Consultant Olive Divranos conducted the Unannounced required annual inspection. LPA arrived unannounced and met with Administrator Brian Buenviaje and assisted with the visit. The purpose for the visit was explained. The facility is licensed for age 60 years and above and all may be non-ambulatory. Currently, the facility has 0 hospice waiver residents and 0 home health residents.

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

1. Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting residents. Staff are cleaning and disinfecting once a day and more often for high touched surfaces. Facility has sufficient PPE supplies and has an Infection Control Plan in place. All staff have the health screening and chest x ray result in file.

2. Operational Requirement: The current plan of operation is completed. A fire clearance approved for 18 residents to be non-ambulatory. LPA obtained the updated copy of facility Liability Insurance in the amount of at least ($1,000,000) per occurrence and total amount of aggregate ($3,000,000) is in place.

3. Physical Plant and Environmental Safety: The facility has two single story buildings in the facility lot. The facility is shared with the Adult Residential Facility (ARF) . The RCFE side has a dining area /TV area, with 9 bedrooms (two beds in each room) there are shared bathrooms between rooms; office; kitchen; extra office/storage room. LPA inspected four (4) rooms which include Room#9, #10 and #3 and #4. There is sufficient closet & drawer space in the bedrooms and all bedrooms have required furniture. There is sufficient closet & drawer space in the bedrooms and all bedrooms have required furniture. Beds are equipped with required linen. The hot water temperature was tested between 111.2 and 121.7 degrees F which is over the Title 22 regulation. There are grab bars near the toilet and in the showers and there is a non-skid mat in bathrooms. Residents are provided with their own soap & hand towels. There is a sufficient supply of extra linen. The washer & dryer are located in the rear of the facility. Laundry soap is locked in a cabinet above the washer & dryer. LPA inspected the smoke detectors and they are all working well. LPA also inspected the carbon monoxide detector is mounted on the wall near Room#9 and it's working properly.