Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with House Manager (HM) Janet Barbardillo. Upon arrival, staff Anthony Makiling 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 two restrooms were inspected. All trash cans were observed with covers. Paper towel were observed with holders. Cloth towels were observed in kitchen and bathrooms. Washing hands for 20 seconds posters were observed at kitchen and bathrooms by the sinks. Three resident shared rooms, one office and one staff live-in room were observed. Beds were observed 6 feet apart. Garage and laundry room were inspected. 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 72 degree F, and hot water temperature was at 110 degree F in facility. Six residents were observed in facility.

Fire extinguisher was serviced on 11/23/2021. 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. No citation were noted today. Exit interview was conducted with HM. This report was provided to HM for signature.