Facility Evaluation Report

At 9:00AM, licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection, and met with administrator (ADM) Daisy Estoresta.

Upon arrival, caregiver Sonia Tapispisan (ST) took LPA's body temperature, asked the infection control screening questionnaires, and checked LPA in the visitor log book. LPA observed the COVID related posters in the facility. LPA observed two staff live-in rooms in facility. Three resident single rooms, one resident shared room, two restrooms, living room, dinning area and kitchen were observed in facility. The trash cans were observed all with covers. Garage was inspected.

LPA checked PPE supplies, PPE supplies were observed sufficient. Cleaning products and detergents were observed locked. Medication closet was observed locked. knives closet was observed unlocked. ADM fixed it immediately. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Cloth towel was observed in the kitchen. ADM stated the cloth towel will be removed. Room temperature was 74 degree F, and hot water temperature was 110 degree F.

LPA discussed LIC808 with ADM. ADM stated all the residents and staff are fully vaccinated. ADM stated the facility already scheduled the booster shots for all residents and staff in two weeks.

No deficiency or allegation was issued today. Exit interview conducted with ADM. This report was provided to ADM for signature. A copy of this report was emailed to ADM.