Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Regional Director (RD) Judy Reyes. Upon arrival, staff Lourdes Go (LG) took LPA's body temperature, asked the infection control questionnaires, and checked LPA in the visitor log book.

LPA observed the COVID posters at main entrance and in the facility. Screening station with gloves, hand sanitizer, thermometer, masks, and visitor log book were observed. LPA toured the facility inside out with staff Teodora Goltiao (TG). Living room, office, kitchen, dinning room, and 2 restrooms were inspected. All trash cans were observed with covers. All paper towels were observed with holders. There are 4 resident single rooms in facility. 4 residents were observed in facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Knives closet, medication closet, and cleaning product closet were observed locked. PPE supplies were observed sufficient. Room temperature was at 68 degree F, and hot water was at 110 degree F.

Fire extinguisher was serviced on 02/10/2021. The facility was equipped with smoke and carbon monoxide detectors. Front yard and backyard were inspected. There was no obstruction observed to block the walkways. RD stated all the residents and staff are fully vaccinated with Pfizer. RD stated the facility is scheduling the booster shots for all the residents and staff.

No deficiency or citation were noted today. Exit interview was conducted with RD. This report was provided to RD for signature. A copy of this report was emailed to RD.