Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection, and met with administrator (ADM) AVELINO R CANLAS . .

Upon Arrival, ADM took LPA's body temperature, and checked LPA in the visitor log book. LPA observed the COVID posters in the facility. One staff and one residents were observed in facility.

LPA toured the facility with ADM inside and out. LPA inspected living room, family room, dinning area, kitchen. There are 2 restrooms, 1 staff live-in room, 3 resident rooms in facility. All the trash cans were observed with covers. Cloth towels were observed in kitchen and in restrooms. There were no posters of washing hands for 20 seconds by the sinks in kitchen and restrooms, but posters of washing hands were observed in kitchen and restrooms. ADM stated ADM will put posters of washing hands for 20 seconds by the sinks in kitchen and restrooms within 1 day. Two days perishable foods and seven day non perishable foods were observed sufficient. Room temperature was observed at 70 degree F, hot water temperature was observed at 110 degree F. Medication cabinet, Knife closet were observed locked. Cleaning products closet was observed locked. PPE supplies were observed sufficient. The facility was equipped with smoke and carbon monoxide detectors. Smoke detector alarm system was tested, and was working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways.

ADM stated all the residents and staff are fully vaccinated and done with booster shots. ADM already submitted the Infection Control Plan to LPA.

No citation was issued today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM.