Senior Care Records.

Facility Evaluation Report

Hacienda Home, San Rafael10/13/2021Licence 216890070

Capacity6
Census5
Date signed10/13/2021 10:28:55 AM
The inspector’s account

Licensing Program Analyst (LPA) Farhaan Sarangi conducted an unannounced Annual Required inspection. The purpose of this inspection is for a Post Licensing. LPA was greeted at the door by Caregiver, Romul Damasco, and granted access into the facility.

LPA toured facility with Care Giver Romulo Damasco . Facility is a one floor building. The facility was inspected and found to be cleaned and at in good repair. Fire Extinguishers are dated for April 2021. Smoke detectors and carbon monoxide detector were found to be working at this time. Hot water temperature could not be checked due to not having a gauge available. The facility has a phone line designated for resident’s use. Hot water temperature measured between 116 degrees F and 108 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in all bathrooms while touring. There was an ample supply of personal hygiene products, bedding and linens, utensils, dishes, and cook ware as per facility. There were emergency supplies available at the time of the visit. Medications, Personnel records and client’s records are stored at the facility in locked cabinets. There was an ample supply of perishable and non-perishable foods. Clients bedrooms have all required lighting & appropriate furnishings as per Title 22 Regulations. Activities are available for residents as per licensee and administrator. There is outdoor space for activities.

LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Mitigation Plan was discussed with licensee via telephone and Caregiver, Romul Damasco. Facility has sufficient Personal Protective Equipment (PPE). Licensee indicated that more PPE is on order. Facility is in the process of being N95 Fit tested. No deficiencies were observed or cited during today's Annual Required inspection. Exit interview was conducted and a copy of this report was emailed to the facility Administrator, Ferdinand Alfonso.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction