Facility Evaluation Report

On 1-4-22 Licensing Program Analyst (LPA) Tirzah Hubbard arrived unannounced to conduct a Required – 1 Year inspection. LPA contacted the facility to ask follow up questions in regard to Covid-19. LPA spoke with the Licensee and Manager Pamela Miranda to ask follow up questions for Covid-19 symptoms. LPA proceeded to approach the facility to conduct the Annual after the facility was cleared. All required COVID measures were observed. LPA observed S1 and Administrator wearing mask upon entry. S1 took the temperature of LPA and asked Covid-19 screening questions. LPA Hubbard were allowed entry into the facility that is licensed to serve a total capacity of 4 clients. LPA interacted with a random number of residents during this visit. The physical plant was toured inside and outside to ensure the safety of the residents.

All required furniture were observed. LPA observed residents engaging in activity, wearing a mask and practicing social distancing. LPA observed the facility conducts fire drills monthly. All bedrooms contained a dresser, bed, and night stand. The flooring of the facility is a good condition. LPA observed the thermostat temperature inside the facility hallway was measured at 76 *F which is within the required range of 68 degrees F (20 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat the maximum shall be 30 degrees F (16.6 degrees C) less than the outside temperature. The hot water was measured at 105 *F which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C) as per Title 22 regulations. LPA observed the centrally stored medications area to be locked and inaccessible to clients. LPA observed 3 of 3 medications counted properly labeled and stored, matching medication administration records (MAR).

All 4 staff are fully vaccinated. Staff will be eligible for June, 2022 Booster vaccination.

All 3 Residents are fully vaccinated. Residents are scheduled for booster for the month of January, 2022.