Facility Evaluation Report

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 11/16/2022 at 09:46am. Facility but the facility was empty. LPA contacted facility Administrator Anita Dela Cruz (Admin), who informed LPA that the facility closed from 08:00AM to 02:00PM while residents are all at their respective day programs. LPA returned to the facility at 03:35pm and toured the facility, including 2 living rooms, kitchen, dining room, garage, 4 bedrooms, 2 bathrooms, and back yard.

All staff members observed to be wearing masks. Admin confirmed that all staff and residents have been vaccinated. Facility infectious control 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 November of 2022. Smoke/carbon monoxide detectors were 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 had no N95s. All restrooms stocked with paper towels. Water temperature observed to be 113.0*F. Hand washing signs observed in all bathrooms. Social distancing signs observed to be posted in all public areas.

No deficiencies cited during today's visit. Advisory notes were issued. This report was reviewed with Administrator Anita Dela Cruz and a copy of the signed report was provided.