Facility Evaluation Report

Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 09/28/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Administrator, Amitis Pourarian, and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask.

LPA notes that the license is still current and active. However, the facility is not in operation at this time as a Day Program.

LPA toured the interior of the facility together with Administrator to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas and two bathrooms. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time.

LPA requested for Administrator to submit documents to Community Care Licensing when the facility plans to operate and accept clients.

Designation of Administrative Responsibility LIC 308

Exit interview. Copy of report provided to facility representative.