Facility Evaluation Report

On 12/9/2021, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA observed COVID-19 signs posted by the entrance. LPA was greeted by the Administrator, Marie Zepeda. LPA explained the purpose of the visit.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, staff training and policies, resident and staff daily monitoring records (LPA recommended to document the temperature that was taken for the staff instead of check mark), containment strategies. there are 5 residents at the facility (2 females and 3 males). PPE supply and the environmental cleaning supply are adequate, bathrooms are equipped with liquid soap and paper towels, hand washing instruction is posted by the hand washing stations. Trash cans are recommended to have foot operated lids. The beds in the shared bedrooms are 6"ft apart from each other.

Medications, toxins and sharps are stored appropriately and inaccessible to resident, a comfortable temperature is maintained, lighting is sufficient for comfort and safety and food supply was checked and observed to be sufficient. First-aid kit is inspected and complete.

During today's inspection, LPA Han requested for the following documents to be submitted to the Regional Office by 12/14/2021:

- LIC 610E Updated Emergency Disaster Plan

- LIC 308 Designation of Administrative Responsibility

No deficiency cited today; this report is reviewed and discussed with the Administrator. A copy is provided.