Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Higinia Alvis, Licensee & Administrator. The annual inspection is focused on the Infection Control procedures and practices of this Adult Residential Facility. Currently, the facility does not have clients in care; last date clients were in the home was on 02/15/2022.

LPA toured the facility with Licensee. Fire extinguisher was charged and serviced on 07/23/2021.

The facility has a supply of PPE including gloves, hand sanitizer, N-95 respirators, gowns, face shields, and surgical masks. Staff have received training from Solano County Public Health on the following topics: infection prevention, symptoms, transmission and PPE use. N-95 mask fit testing for staff (Cal/OSHA requirement) is in process. The facility has submitted a COVID-19 Mitigation Plan Report on Epidemic Outbreaks specific to COVID-19 which was reviewed by the California Department of Social Services, Community Care Licensing. All staff wore masks during this visit.

LPA requested the following updated records to be submitted to Community Care Licensing by 05/16/2022

· LIC 308 Designation of Facility Responsibility

· LIC 400 Affidavit Regarding Client/Resident Cash Resources

· Copy of current Administrator's Certificate

· Copy of current Lease/Rental Agreement or Property Tax document showing control of property.

Exit interview conducted with Licensee, whose signature on this document confirms receipt.

No deficiencies cited during this inspection