Facility Evaluation Report

On this day at , Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced infection control annual inspection. LPA met with licensee Nelia Asuncion and explained purpose of today's inspection.

LPA toured the physical plant inside and out. There are no accessible bodies of water or fire safety hazards observed. COVID postings and hand washing signs are present inside the facility but not on the main entrance. Hand sanitizer is observed as readily available through out the facility. Infection control practices are reviewed: entry procedures, staff training and policies, resident monitoring, containment strategies, environmental preparation and cleaning. PPE supply is observed as in place. Medications, toxins and sharps are stored appropriately and inaccessible to clients. Facility ambient temperature is warm and comfortable, and lighting is sufficient for residents and staff safety. Toilet and bathing facilities are equipped with grab bars and non-slip flooring material. Liquid soap is available. Paper towels present in common bathroom in hallway. Water temperature is tested in hallway bathroom at 105F. First-aid kit is inspected and is complete. A Disaster and Mass Casualty Plan is present. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been finger print cleared and associated to the facility. Administrator certificate is viewed as current expiring 12/23/2022. Mitigation plan is reviewed with the administrator.

The following updated forms are requested to be submitted to CCLD by 07/08/2022 :

• LIC 308 Designation of Administrative Responsibility

• LIC 400 Affidavit Regarding Client Cash Resources

LPA provided technical assistance today on attached LIC9102.