Facility Evaluation Report

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

LPA toured the facility inside out with HM. COVID posters were observed at main entrance and the facility. Screening station with masks, hand sanitizer, thermometer and visitor log book was observed at the main entrance. Living room, family room, kitchen, dinning room and three restrooms were inspected. All trash cans were observed with covers. Paper towel in one restroom was observed without holder. HM stated the facility will put the paper towel with holder today. Three resident bedrooms, and laundry room were inspected. One staff live-in room and one office were observed in facility. Cloth towels were observed in kitchen. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. PPE supplies were observed sufficient. Medication closet, knives closet, and cleaning product closet were observed locked. Room temperature was at 71 degree F, and hot water temperature was at 110 degree F in facility.

Fire extinguisher was serviced on 10/07/2022. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by HM, and were working fine. 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. HM stated the facility already submitted Infection Control Plan to CCL office. No citation were noted today. Exit interview was conducted with HM. A copy of this report was provided to HM..