Facility Evaluation Report

Licensing Program Analyst (LPA) Calzada arrived unannounced to conduct a required annual inspection. LPA met with Amalia Eslao, caregiver, who contacted Administrator by phone to advise of inspection. LPA explained purpose of inspection to caregiver. Administrator, Maria So, arrived at the facility at approximately 2:40 pm. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, contacted the facility to confirm there are currently no positive Covid-19 diagnoses, 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 community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical Mask. There are (6) residents at the facility and (1) resident is currently receiving hospice services.

LPA observed two residents to be watching television in the front room at the start of the inspection. LPA and caregiver toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, (4) resident bedrooms, (3) restrooms, kitchen, dining room, laundry area/large shower room.. 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 compliance at this time. Inside temperature was observed to be 74* F.

LPA discussed the annual with each Co-Administrator that daily temperatures taken for staff and residents should be documented. Also discussed how screening criteria can be printed on a half page for visitors to complete upon entry to the facility.

There are no deficiencies being issued today.

Exit interview. Copy of report left at facility.