Facility Evaluation Report
On October 17, 2022, Licensing Program Analyst (LPA) Komal Charitra and Licensing Program Manager (LPM) Cara Smith conducted an unannounced annual infection control inspection. Upon arrival, LPA observed the COVID-19 signage posted at the front door. LPA Charitra and LPM Smith met with Caregiver, Maan Penaflor and Caregiver, Rosalie Paule and explained the purpose of the visit. LPA and LPM were screened at entry point and Caregiver was able to provide LPA screening log documentation for staff, visitors, and residents.
LPA toured the facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a single story home with 3 resident bedrooms, 2 full bathrooms, and a staff room with a full bathroom. LPA toured the facility and observed living room and dining room to be clean and clear from any tripping hazards. A comfortable temperature is maintained and lighting is sufficient for comfort.
LPA toured the resident rooms and observed all 3 resident rooms to be shared bedrooms with beds 6ft apart or 3ft head-to-toe. LPA observed 2 full bathrooms to be equipped with liquid soap, paper towels, hand-washing signs, non-skid mats, and a trash can with a fitted lid. Bathrooms were odor-free and in good repair. LPA observed extra linen present. First aid kit was observed to be completed. LPA toured the kitchen and observed 2 day perishable and 7 day non-perishable. Sharps and medications were observed to be locked and inaccessible to residents.
LPA toured the garage and observed toxins and chemicals to be stored appropriately and inaccessible to residents. According to the Caregiver, the garage door stays locked at all times. Washer and dryer were observed to be in good repair. 30-day PPE supply was present. LPA toured the staff room downstairs and observed a full bathroom. Staff room was observed to be clean.
Infection control practices are observed: entry procedures, daily monitoring log for staff, residents and visitors, 30-day PPE supply, face coverings for staff, containment strategies, staff training and policies.
No citations will be issued during this visit. Report is reviewed with Caregiver and a copy is provided.
LPA requests the following forms to be submitted to CCLD by 10/24/22:
-LIC308 Designation of Administrative Responsibility
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction