Facility Evaluation Report

At 11:00AM, licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection, and met with House Manger Tina Munoz (TM). .

Upon Arrival, TM took LPA's body temperature, asked infection control questionnaires, and checked LPA in the visitor log book. LPA observed the COVID posters in the facility. One staff and five residents were observed in facility.

LPA toured the facility with TM inside out. LPA inspected living room, family room, dinning room, kitchen. There are 2 restrooms, 3 resident shared rooms, and 2 staff live-in rooms in facility. Some trash cans without covers were observed in facility. Some paper towels without holders were observed. TM stated the facility will fix the issues in one day. TM stated the facility will remove the extra chairs in dinning room. Two days perishable foods and seven non perishable foods were observed sufficient. Fire extinguisher's service date was observed on 7/14/2021. Room temperature was observed at 68 degree F. Medication cabinet, Knife closet, and cleaning products closet were observed locked. PPE supplies were observed sufficient. Smoke dictators were tested and were working fine.

Front yard and back yard were inspected. No obstruction was observed to block the walkway.

TM stated all the residents and staff are fully vaccinated and done with booster shots.

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