Facility Evaluation Report

Licensing Program Analyst (LPA) Rachael De Leon arrived at 10:30am to conducted a 1 year annual visit to the facility above. LPA met Administrator Stephanie Avila 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 an Infection Control Plan to the department. The facility has a sign in and out kiosk for Staff, Residents and visitors. The bathrooms have toilet paper, paper towels, and hand soap. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Staff are trained on infection control and the use of Personal Protective Equipment (PPE) on hire and annual there after.

Physical Plant & Environment Safety: The facility is 14 bedroom with 14 private bathrooms and 1 common areas restrooms currently occupying 13 residents and employs 15 staff of which 3 certified Administrators. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has dual smoke and carbon monoxide detectors, hard wired with sprinkler system. The lighting and lamps are sufficient for the use of the facility and for residents comfort. The facility kitchen is clean, safe and sanitary. The showers have non-skid textured floors or mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The facility has a pendant system and pull cords in each residents bathroom. All pathways are clear of any obstruction.

Personnel Records & Training: The facility keeps confidential files for each staff member. LPA reviewed 5 staff training records for Initial and/or Annual Training Requirements of 20 plus hours meeting 8 hours of dementia training with all subjects covered over a 3 year period, 4 hours of hospice care, postural supports and restricted health condition and 8 hours of other training to include ADL's, resident characteristics, emergency preparedness policy and procedures, infection control requirements and Quarterly Disaster Drills are conducted. Continued 809-C