Facility Evaluation Report

At 2:25PM, Licensing Program Analyst (LPA) Steve Chang arrived at facility to conduct the Annual Inspection. Upon arrival at facility, staff Elvira Mones (EM) took LPA body temperature, asked LPA the infection control questionnaires, and checked LPA in the visitor log book. LPA observed the COVID-19 posters in the facility. LPA observed hand sanitizer at many places in the facility. LPA obtained the roster of staff and residents.

LPA toured the facility inside out with EM. LPA met with staff Jesus Cera (S2) and Cemma Gayapa (S3). LPA observed 5 residents (R1 - R5) in facility. There are 3 resident bedrooms, two bathrooms, and one staff room in facility. LPA observed all the trash cans in the bedrooms, bathrooms, kitchen, and common areas have the covers. LPA observed all the staff wore masks in the facility.

LPA observed knives are kept in locked closet, and detergent are locked. LPA observed the medication closet was locked. LPA observed 2 day perishable food and 7 day nonperishable food are sufficient. LPA observed the facility has sufficient PPE supplies.

LPA discussed and reviewed LIC808 with ADM.

No citation were issued during today's inspection. Exit interview conducted with ADM. This report was provided to ADM to review and to sign. A copy of this report was emailed to ADM.