Facility Evaluation Report

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility for the purpose of annual inspection with focus on infection control. LPA met with facility manager, Hoang Truong, who was informed of the purpose of the visit.

LPA conducted a walk through of the interior and exterior of the facility. LPA observed resident bedrooms that would be used a isolation rooms.

LPA observed the following COVID-19 related violations:

Facility staff and residents were not wearing a mask

(3) out of (3) resident restrooms did not have hand soap

LPA was not screened when entering the facility and staff was not trained on how to screen visitors

Resident temperature checks were not being taken or recorded everyday.

Facility lacked COVID-19 postings throughout the facility

These will be documented on LIC9102TV Technical Violation Form.

LPA along with facility manager observed the following deficiencies:

Identification and Emergency Information was not filled out for R1 who has been admitted to the facility for (3) months.

Resident restroom had unlocked cleaning supplies

Facility was not incompliance with the required (1) week supply of non-perishable food items

Deficiencies were documented on LIC809-D.

An exit interview was conducted where this report along with LIC809-D pages, LIC9102TV pages, and appeal rights were reviewed and provided to facility manager.