Facility Evaluation Report

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 03/29/2022 at 09:45am. LPA met with facility Administrator Perla Cayabyab (Admin).

LPA toured the facility, including living room, kitchen, dining room, laundry room, 5 bedrooms, 3 bathrooms, and back yard. One staff member observed to not be wearing mask when assisting resident, all other staff were masked. Admin confirmed that all staff and residents have been vaccinated.

Facility Mitigation plan has already been submitted. No prohibited items noted in resident rooms. All emergency exits noted to be clear of obstruction. All rooms in facility noted to be clean and well maintained. Hand sanitizers, soap, and paper supplies were observed to be available. At least 2 days' supply of perishable food and at least 1 week's supply of non-perishable food was observed on the premises. Fire extinguisher observed to be inspected in February 2022. All cleaning supplies and chemicals noted to be in locked cabinets and closets. Smoke/carbon monoxide detectors tested and observed to be operational.

Facility observed to have designated entry point. Staff took LPA's temperature and screened for symptoms. 30 day supply of PPE was not observed, as the facility did not have N95 masks. Hand washing signs were observed in facility bathrooms. Water temperature observed to be 110 *F in 2 bathrooms. Social distancing signs observed to be posted in all public areas.

No deficiencies cited during today's visit. This report was reviewed with Administrator Perla Cayabyab and a copy of the signed report was provided.