Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted a annual inspection visit, and met with administrator (ADM) Marieson Floreza. Upon arrival, ADM took LPA body temperature and checked LPA into the guest book. Screening station with thermometer, masks, hand sanitizer was observed at the main entrance. COVID posters were observed at the main entrance and in facility. 6 residents and 3 staff were observed in facility.

LPA toured the facility inside and out with ADM. LPA inspected living room, kitchen, dinning area, and laundry room. Medication closet, knives closet, and cleaning product closet were observed locked. There are 3 shared rooms for residents, one office, and two staff live-in rooms in facility. 2 bathrooms were inspected. Pll paper towels were with holders, Cloth towels were observed in kitchen and restrooms. Trash cans were observed with covers. 2 days perishable food supplies and 7 days food supplies were observed sufficient. Room temperature was observed at 73 degree F, and hot water temperature was observed at 110 degree F.

The facility is equipped with smoke and carbon monoxide detectors. The facility equipped with fire alarm. ADM tested the smoke and carbon monoxide detectors, and they were working fine. The fire extinguishers were observed on service on 03/21/2022. LPA inspected the backyard, there was no obstruction to block the walkway.

ADM stated all staff and residents are fully vaccinated and done with booster. ADM already submitted the Infection Control Plan.

No deficiency or issue noted during inspection. Exit interview was conducted with ADM. This report was provided to ADM for signature.