Facility Evaluation Report

Licensing Program Analyst (LPAs) Arlene Garcia and Albert Johnson conducted an unannounced annual / Infection Control visit on this date. LPAs were greeted Maria Serrato, Caregiver S1, and met with Christine Quiruz, Administrator .

LPA and S1, inspected physical plant including but not limited to the main kitchen, residents bedrooms and bathrooms, and dining/ living room areas.

LPA observed 2nd bathroom under construction and no hot water not coming out of sink.

LPA observed sufficient 7 days non-perishable and 2 days perishable food supplies.. Hot water temperature measured 110 degrees in residents bathroom with the AD which is in required range of 105 to 120 degrees.

Last Fire Drill conduced dated 7/01/21. Fire extinguisher maintained 11/22//2020.

Fire alarm and carbon monoxide functional. LPA observed sharps and toxins locked.

LPA and AD observed centrally stored medications.

LPA reviewed 4 staff and 5 resident files. Resident emergency contact complete. LPA observed all staff files complete.

Administrator Certificate valid until 11/6/2022.