Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Paz Yntela, DSP and Sally Banagan, DSP, who contacted Administrator by phone and explained purpose of inspection. LPA observed Job Udi, DSP, to be leading a game of Bingo with (5) clients during the start of the inspection. LPA observed all staff to be wearing masks. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. Administrator, Eveleth R. Purugganan, arrived at 1:50 pm. The facility is a licensed level (4H) home and is vendorized through Alta California Regional Center.

LPA and DSP, Paz Yntela, toured the interior and exterior of the facility, including (4) private resident bedrooms, (2) shared resident bedroom, (2) bathrooms, kitchen, common areas, sanitation station next to laundry area, office and garage/storage area. LPA observed all areas toured to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. Inside temperature was observed to be 71* F. Fire extinguisher last serviced 1/15/2022. LPA observed locked toxins, medications and sharps and sufficient 2+day perishable/7+day non-perishable food. First aid kits on site. Smoke/ monoxide alarms in working order. Facility conducts quarterly fire drills. LPA observed paper towels, soap, sanitizer, and hand-washing posters, trash cans with lids in the bathrooms and sufficient PPE supply and incontinent products, activities, and books. LPA observed various Covid posters outside the front entrance and throughout the facility along with other required postings. Discussed vaccination status of residents/staff, eligibility for boosters and visitation protocols per PIN 22-07. All staff are cleared/associated. LPA and Administrator completed the Infection Control Domain portion of the annual tool. LPA reviewed (1) resident file and observed it to be current and organized.

LPA requested an updated copy of LIC500 and LIC308 by 6/13/22. Exit interview. There were no deficiencies observed during today's inspection.