Facility Evaluation Report

Licensing Program Analyst Cassie Yang arrived at the facility unannounced to conduct a Required 1 Year inspection. LPA met with staff, Freddie Galvez , 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility.

LPA Yang was informed that CCLD was not allowed to conduct unannounced visit from Monday -Wednesday due to prearranged obligations the facility had with Department of Development Services (DDS). LPA was informed that DDS emailed CCLD that the facility was filming a training material, the 5 Rights video, for appropriate self-administration of medication.

LPA Yang consulted with LPM Maribeth Senty who requested for further information since LPM was not aware of this matter. LPA Yang spoke with production crew, Joe, and was given the DDS contact. LPA contacted and spoke with DDS Training Coordinator, Esther Sibal, who forwarded the original email notification to LPA. It was confirmed Sibal had emailed LPM Anthony Perez regarding this matter on 06/03/2022 at 12:36 pm.

LPA Yang and LPM Senty agreed it was best to exit the facility and continue the annual inspection a different day.

On 06/16/2022 at 9:55 am, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility unannounced to conduct a Required 1 Year inspection. LPA met with staff, Freddie Galvez, who informed LPA that Edmon Orian, House Manager, is at a doctor's appointment. LPA observed Administrator, Gary Tateishi, leaving the facility taking a resident to an appointment. LPA completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and was requested to do so also upon entering the facility. The following Personal Protective Equipment (PPE) was worn: surgical mask. LPA observed (2) residents sitting in the common area.

LPA and staff, Freddie Galvez, toured and observed the facility to ensure the health and safety of residents in care. Areas toured include, but are not limited to: common areas,(6) private bedrooms, (4) private baths, dining room, laundry area and kitchen. LPA observed cough etiquette signs to be posted throughout the facility. LPA advised Galvez to post a "Mask Required" sign at the front door for visitors. LPA observed 2+day perishable and 7+day non-perishable food supply. PPE supplies for 30+days on hand. LPA observed locked toxins, medications and sharps. LPA observed (2) fire extinguishers to be up to date, last serviced on 07/14/2021. LPA observed the facility to have documentation of staff and residents temperature and daily screenings. LPA observed the Administrator Certificate #6028439735 to be up to date, expiration of 02/03/24. In the areas toured, there were no immediate health, safety, or personal rights violations observed. LPA and staff completed the infection control domain and facility was found to be in compliance at this time.

LPA informed facility to have postings of Ombudsman sign, and IF YOU SEE SOMETHING, SAY SOMETHING sign. LPA advised facility to have all restroom trash bins to have lids.

LPA requested Administrator to send an updated copy of LIC 308 Designation of Facility Responsibility for Freddie Galvez, and a copy of the Liability insurance via email by 6/23/2022.

No deficiencies are being cited as a result of today's inspection.

Exit interview conducted and copy of report left at the facility.