Facility Evaluation Report

At 12:40PM, Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with administrator (ADM) Cecilia Valnezuela.

Upon arrival, Caregiver Gregorio Locquiao (GL) took LPA's body temperature, and asked the screening questionnaires, then checked LPA in the visitor log book. COVID posters were observed in the facility. LPA toured the facility with GL. There are two staff live-in rooms in facility for 4 staff. There are 3 shared rooms for residents, and 2 restrooms in facility. Beds in the resident rooms were observed 6 feet apart. Two staff and three residents were observed in the facility. Two residents went out for day program. LPA toured the kitchen, dining room, family room, and garage. LPA observed that not all the trash cans with covers, and not all the paper towel with holders. ADM stated the facility will fix the issue today.

The room temperature was 76 degree F. And the hot water temperature was 106 degree F. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet was observed locked. Cleaning chemical products were observed locked. PPE supplies were observed sufficient. LPA toured backyard with ADM. No obstacles were observed blocked the walkway in the backyard. ADM's husband bought and brought the trash cans with food pedal cover when LPA was writing the report.

LPA reviewed the LIC808 with ADM. ADM stated all the staff and residents are fully vaccinated. ADM stated ADM is scheduling the booster for all residents and staff.

No deficiency or allegation was issued today. Exit interview was conducted with ADM. this report was provided to ADM for signature. A copy of this report was emailed to ADM.