Facility Evaluation Report

On 12/27/2022 at 3:05pm, Licensing Program Analyst (LPA) Simi Rai conducted an unannounced annual required inspection and met with Staff Mary Pine. Administrator Carlito Ocampo was informed via telephone.

During visit, LPA Rai toured the facility to include the family room, living room, dining room, kitchen, 3 bedrooms, 1 staff room, 2 bathrooms, garage, and backyard. All fire exit routes were free and clear of obstruction. All staff observed wearing a face covering. LPA observed 5 clients at the facility.

Facility has a designated entry point for sign-in, symptom screening, and temperature check for all visitors and staff. Hand sanitizer made available at entry and throughout the facility. Visitation guidelines posted at the entrance. Bathrooms supplied with hygiene products, paper supplies, and hand washing sign. LPA Rai observed facility's Personal Protective Equipment (PPE) supplies. Facility has procedures to isolation and testing for COVID-19. Staff are trained on infection control. Staff are N95 fit tested. Facility staff clean and disinfect multiple times daily and as needed. The following posters observed to include wash your hands and symptoms of COVID-19.

LPA Rai observed an activity room in the Open Patio area on the facility sketch. LPA Rai spoke to ADM, and he stated the activity room has been part of the house since obtaining the license. LPA Rai notified ADM the last facility sketch provided to Department on November 17th, 1994 does not show an Activity Room. Administrator will submit new facility floor plan to LPA Rai by Wednesday, December 28, 2022.

LPA Rai observed a no visitor sign posted at the front door. Staff removed the no visitor sign during visit. LPA Rai advised of the visitation guidelines per PIN 22-28.1-ASC.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Staff Mary Pine and a copy of the report was provided.