Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Nely Gaba and Alex Gaba, caregivers and explained purpose of inspection. 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 not 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. The facility is a licensed home that is vendorized through Alta California Regional Center. There are (6) clients who reside at the home. LPA observed (3) residents in the common area and (1) resident sleeping at the start of the inspection. (2) additional residents returned from their job or day program during the inspection. Sheryl Zonio, Administrator, arrived at approximately 3:45 pm.

LPA and caregiver, Nely, toured the interior of the facility including the common areas, client (6) bedrooms, (2) bathrooms, kitchen, laundry, second activity room/office and observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed various Covid posters throughout. Inside temperature was observed to be 76* F. Fire extinguisher last serviced 5/15/2021.

LPA observed sufficient 2+day perishable/7+day non-perishable food. LPA observed paper towels, soap, sanitizer, trash cans with lids and hand-washing posters in the bathrooms. LPA observed sufficient PPE supply on hand including an emergency PPE supply kit. LPA and and Administrator discussed the vaccination status of residents/staff as well as visitation protocols per PIN 21-40. LPA observed documentation of daily temperature checks for residents/staff and a binder with PINS that have been issued throughout the pandemic. Administrator to post signage the front entrance that masks, documentation of vaccination status or negative Covid test within 72 hours are required upon entry. Administrator stated that there are minimal visitors and they visit outside on the front porch usually.

LPA requested an updated copy of LIC308 during today's inspection by 12/16/2021. There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator who was informed that a subsequent annual inspection could be conducted on/around 4/9/2022.