Facility Evaluation Report, 11/18/2021 — Care Plus Home, South San Francisco CA

Licensing Program Analyst (LPA) Tobola arrived unannounced to conduct a Required - 1 Year inspection and met with House Manager, Edwin Bactad (EB). LPA contacted Licensee James Hsiao and notified of the inspection. The annual inspection is focused on the Infection Control procedures and practices of this Adult Residential Facility. The re are 6 clients in care, 1 of which was with family at the time of visit.

LPA toured facility and grounds with House Manager and observed COVID-19 precaution signs posted in common areas to promote hand washing and physical distancing. LPA was screened for COVID-19 symptoms upon entrance to this facility. Visitors are said to be screened for COVID-19 symptoms (including temperature check) upon arrival to the facility. Facility has not submitted a mitigation plan to CCL for review. LPA informed that staff do not monitor clients for symptoms on a daily basis. LPA explained the importance of monitoring for COVID to House Manager. LPA observed at least a 30-day PPE supply for client use. Cleaning and disinfecting the facility common areas is conducted three times per week and staff stated high touched surface areas are disinfected after each use, such as the bathroom and kitchen area. Common areas are equipped with hand sanitizer and masks available for client use. Bathrooms are equipped with liquid soap and paper towels available upon client request. Caregivers have completed PPE training as well as N-95 Mask Fit Testing Training for all staff.

In addition, facility was found to be at a comfortable temperature with all exits free from obstruction. No accessible bodies of water were observed. Fire Extinguisher was missing service tag with no receipt to indicate the last inspection or purchase date. Smoke and Carbon monoxide detectors were tested and fully operational.

There was sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit.