Facility Evaluation Report

On 09/20/2022, Licensing Program Analyst (LPA) Jessica Cho conducted an unannounced visit to Adult Care OC I. The purpose of today's visit was to conduct a Required 1 Year focusing primarily on the Infection Control. At 2:14pm, LPA Cho was greeted and allowed entry by Care Staff Demetrey Dicen and completed the Coronavirus 2019 (COVID-19) screening procedure. Care Staff Erwin Calibara was also present today. Licensee/Administrator (Admin) Brian Schott greeted LPA around 2:20pm. Administrator (Admin) Fe Szalonek joined shortly after around 2:28pm. As of today, there are no active COVID-19 cases. Facility screens and documents temperatures for visitors on a sign in sheet. LPA observed the required COVID-19 precautionary signs throughout the facility. The Complaint Poster (PUB475) met the size requirement. The facility is licensed for one ambulatory, five non-ambulatory residents, and has a hospice waiver for six. There are currently five residents living in the facility of which three are receiving hospice care.

At 2:30pm, LPA Cho conducted a tour of the physical plant with Licensee Schott and Admin Szalonek. The two-story home consists of five resident bedrooms and four resident bathrooms. There is one staff bedroom and bathroom. On the first floor, the facility also has a living room, dining room, staff break room (with a bed), kitchen, and an attached two car garage with a laundry area. The second floor is the living area for the Licensee/Admin Schott. The resident bedrooms had the required furnishings, bed linens, and closet/drawer space to accommodate each resident comfortably. LPA observed a mounted camera above the doorframe in the bedroom of Resident 1 (R1). Per Licensee Schott, the family of R1 requested and verbally consented to the use of a camera due to R1 being a fall risk. The camera was immediately removed from the bedroom. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, showers were free of mold/mildew, and non-skid mats were in place. Resident bath towels and personal hygiene supplies were adequately stocked including paper towels and hand soaps. LPA observed hand washing signs in the bathrooms.