Facility Evaluation Report
On November 10, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual infection control inspection. Upon arrival, LPA observed the COVID-19 signage posted at the front entrance. LPA met with Caregiver, Michael Ponce and explained the purpose of the visit. 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 4 bedrooms and 2 full bathrooms. LPA observed 3 resident bedrooms to be shared rooms with beds 6ft apart or 3ft head-to-toe. LPA observed one bedroom to be a staff room. LPA observed 2 full bathrooms and advised caregiver to ensure both bathrooms have a hand-washing sign, trash can with a fitted lid, and to substitute the hand-towels for paper towels. Bathrooms were clean and odor-free. Extra linen was observed to be present.
LPA toured the living room and dining rooms and observed it to be clean and free from any tripping hazards. A comfortable temperature is maintained and lighting is sufficient for comfort. During the visit, there were 5 residents observed. 2 staff were observed with face masks. LPA toured the kitchen and observed 2 day perishable and 7 day non-perishable. LPA advised Caregiver to remove hand-towels. Sharps were stored appropriately an inaccessible to resident and medications were observed to be locked.
LPA toured the garage and observed chemicals and toxins to be locked. In addition, LPA observed washer and dryer to be in good working condition and observed extra food supply present. 30-day PPE supply was present. First aid kit was observed to be completed.
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.
LPA requests the following forms to be submitted to CCLD by November 17, 2022:
-LIC308 Designation of Administrative Responsibility
No citations will be issued during this visit. Report is reviewed with Caregiver and a copy is provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction