Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with House Manager (HM) Senen Semana. Upon arrival, HM took LPA body temperature, and checked LPA in the visitor log book.

LPA toured the facility inside out with HM. There were no COVID posters on the main door. HM stated the facility will put the COVID posters on the main door. COVID posters were observed in the facility. Masks, hand sanitizer, glove, thermometer and visitor log book were observed in facility, but there were no dedicated station for that. HM stated the facility will have a dedicated csreening station. Living room, kitchen, dinning room and two restrooms were inspected. Some trash cans were observed without covers. HM stated the facility will have all the trash cans with covers in 5 days. Paper towel was not observed in kitchen. HM stated the facility will put the paper towel with holder in 5 days. No posters of washing hands for 20 seconds by the sinks in kitchen and in restrooms. HM stated the facility will put the posters of washing hands for 20 seconds in kitchen and in restrooms in 5 days. Cloth towels were observed in kitchen. Three resident bedrooms, and laundry room were inspected. Two staff live-in rooms were observed in facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet, and cleaning product closet were observed locked. Room temperature was at 80 degree F, and hot water temperature was at 106 degree F in facility.

Fire extinguisher was serviced on 08/03/2022. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by HM, and were not working. HM stated the facility will change the battery. Front yard and backyard were inspected. There was no obstruction to block the walkways.

HM stated all the residents and staff are fully vaccinated and done with booster. The facility already submitted the LIC9282, infection control plan to LPA. No citation were noted today. Exit interview was conducted with HM. This report was provided to HM for signature.