Facility Evaluation Report

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required annual inspection focusing primarily on the Infection Control. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty who checked temperature prior to entering facility. During the visit, there was one staff on duty, who contacted facility administrator (AD) Marites De Vera about visit. As of 10/7/22, there are 0 active COVID-19 cases in the facility as verified. LPA De Perio observed the COVID-19 precautionary signs posted throughout the facility. The PUB475 "See Something, Say Something" poster was also observed in the hallway of the facility. LPA De Perio observed the Administrator's Certificate for Marites De Vera which expires on 3/20/2024.

LPA De Perio toured the interior and exterior portions of the facility with staff on duty (S1). The facility is a two level structure and is licensed for 6 ambulatory clients, however Regional Center has vendored the facility for 4 clients. Currently, there are a total of 4 clients in care. On the first level, there are a total of 6 bedrooms of which 3 are for staff, and 1 shared room for clients and there are two 2 single rooms for clients. All bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. On the second level, there are two bedrooms which are utilized for AD's family. LPA De Perio observed and verified that the second level is not for client use and observed no clients residing on the second floor. LPA De Perio also conducted file reviews to confirm that live-in family members have been cleared and completed a background check.