Facility Evaluation Report

Licensing Program Analyst (LPA) De Leon arrived at 10:30 am to conducted a 1 year annual visit to the facility above. LPA met with Administrator Kylan Reynoso and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit:

Infection Control: The facility has submitted a current Infection Control Plan. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. PPE and infection Control Training is done initially upon hire and annually thereafter. All sinks have soap, paper towels, hand washing signs.

Physical Plant & Environment Safety: The facility is a 3 bedroom and 2 bathroom home currently occupying 3 residents with 1 bedroom being shared. The facility employs 9 staff and 1 administrator. The facility is clean, safe and sanitary. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. The facility is fully fenced around the backyard with a self closing and latching gate. The facility has a patio with furniture and awning for shade. Laundry room is in the garage and has a working washer and dryer, garage is kept locked with all laundry and cleaning supplies. Water was tested in bathroom #2 at 105.7F.

Operational Requirements: The Facility is operating in compliance with granted fire clearance. The facility is cleared for 4 non-ambulatory with a Hospice wavier granted for 4. The facility liability insurance expires 09/01/2026.

Staffing: The facility employes 9 staff and 1 Administrator. Staff records are kept confidential. Staff records were reviewed for 5 staff for fingerprint clearance and associations, personnel record or application, First Aid and CPR valid certificates, CPI valid training certificates and Health screening with TB results.

Resident Rights Information: All require postings were posted in common areas of facility. Personal rights, Rights to Resident Council, Theft and Loss policy, Nondiscrimination notice in addition to a CCL Complaint poster and LTCO posted. Continued 809-C