Facility Evaluation Report

On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted and granted entry into the facility by Administrator Helen Hafalia and explained the nature of the visit. This facility is licensed to provide services to 6 Ambulatory Clients. Facility is a level 2 home. Administrator (AD) AD Helen Hafalia has an Administrator Certificate with expiration date of 08/30/2022.

On or about 9:51am LPA Quiroz along with AD Helen Hafalia toured the inside and outside of facility. Two staff working at facility were observed to be wearing face masks upon arrival to facility. There are three clients in care and there are no active COVID-19 cases. During today's inspection visit, LPA Quiroz interacted with two of three clients in care. LPA Quiroz observed Client 1 (C1) in living room area, and Client 3 (C3) in his bedroom watching television. AD Hafalia indicated Client 2 (C2) is currently at Goodwill working. During today's visit, 2 of 3 clients present at facility appeared to be clean and well taken care of. LPA Quiroz observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer and appeared clean. LPA Quiroz inspected clients’ bedrooms and appeared clean and sanitary. All bedrooms observed to have all required components. LPA Quiroz observed a check in station in the main entry of the facility. Facility is taking temperatures daily and documenting results. LPA Quiroz observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water supply as well as PPE supplies. LPA Quiroz toured the outside of the facility and observed seating area with table and chairs for client’s enjoyment in the front and back yard area. Facility has completed the LIC 808 Mitigation plan which was approved by Licensing Evaluator Jung Mi Han on 4/17/2021