Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Rosemarie Vister, live-in staff . Administrator was unavailable during day and time of inspection. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly.

LPA toured the facility and observed a visitor sign-in sheet, thermometer, and hand sanitizer. The facility food supply was observed per regulation. LPA observed COVID-19 precaution postings, liquid hand soap and paper towels available in bathrooms. During this inspection, the facility received citations and civil penalties for 3 of the various deficiencies observed. Do to time constraint, LPA will return unannounced at a later date to review additional items and complete the inspection.

LPA requested the following updated forms to be submitted to Community Care Licensing by 02/20/2023:

· LIC 308 Designation of Facility Responsibility (1 person per form)

· LIC 400 Affidavit Regarding Client/Resident Cash Resources (indicate if not handling cash for residents)

· Copy of current Administrator's Certificate

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