Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso, conduct a Required- 1 Year inspection and met with Administrator Edwardson Manalo. There are currently two (2) residents on hospice care.

Facility has a required infection control plan. Facility has a required emergency disaster plan. Facility has an approved hospice waiver for residents in care as needed. There is an approved plan of dementia care. Fire clearance is approved for six (6) non-ambulatory.

The LPA reviewed four (4) client files. The LPA reviewed six (6) staff files. All staff had criminal record clearance as required.

LPA toured the facility with Administrator. Hot water was checked 112.8 Fahrenheit. LPA observed all exits to be free of obstructions. Fire extinguisher is tagged and serviced as required. Napa Fire Department came out and inspected the fire alarm system, passed inspection, 8/8/2023. Facility's smoke alarms are also carbon monoxide detector; There are also two separate smoke alarms. Food supply was observed to be sufficient. The facility was clean and orderly. Facility had a sufficient supply of hygiene products, cleaners, and paper products. Facility had a sufficient supply of personal protective equipment (PPE). Bathrooms had roll in showers, grab bars, and mats for resident use. Facility had night lights for resident use as needed. LPA observed a 72 hour shelter in place supply, which is required.

Licensee/Administrator to submit the following documents by 11/23/23:

LIC 308 Designation of Administrative Responsibility

LIC 610 E Emergency Disaster Plan for RCFE -reviewed & updated as needed

Infection Control Plan-reviewed & updated as needed

LIC400 Handling of Client Cash Resources, include copy of surety bond.