Facility Evaluation Report

On 1/12/22 at 9:51am Licensing Program Analyst (LPA), Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Marcelina Lagua and explained the purpose of the visit.

LPA Bilger inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 5. Facility has 4 bedrooms, 2 shared and 2 private. Facility also has 2 bathrooms for client use. There is a dining area off the kitchen and a formal living/tv area.

The facility has an approved COVID Mitigation plan LIC 808 form in place.The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and back yard. The facility has a designated infection control lead. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use.

Water temperature reads 112.4*F in the bathroom and room temperature reads 74*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 1/5/22. Facility has an emergency food and water kit and 30-day supply of PPE. Fire drills are conducted quarterly. Records for Staff1 (S1), S2, S3, S4, S5, S6, S7 reviewed. Based on record review S5's first aid/cpr card was missing from file. All staff vaccination records verified. Fingerprint clearances were verified for all staff.

Per California Code of Regulations, Title 22, division 6 deficiencies were observed during this visit. Exit interview was held with Marcelina Lagua and a report was given to Marcelina. Appeal rights provided