Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Dante Ward, Licensee. The annual inspection is focused on the Infection Control procedures and practices of this Adult Residential Facility.

LPA conducted a walk-through of the facility with licensee and observed COVID-19 precaution postings and a screening station at front entrance. The facility has designated visitation areas, provides virtual visits and phone calls for loved ones to stay in contact with clients. LPA observed 1 client in care. Staff have First Aid and CPR certifications. The facility has a supply of PPE including gloves, N-95 respirators, and surgical masks. 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.

LPA discussed the following requirements with Licensee:

· Documenting staff daily temperatures and COVID symptom screening questionnaire.

· Screening station visitor sign-in sheet to include a section for COVID-19 screening questionnaire and section to document verification of COVID-19 vaccination (or negative COVID-19 test) for indoor visitation.

· Wearing masks regardless of vaccination status.

· Staff training on the following topics: infection prevention, symptoms, transmission and PPE use.

· N-95 respirator Fit testing (Cal/OSHA requirement) for staff. Licensee to obtain documentation for completion for CCL verification.

· Conducting and documenting earthquake and fire drills every 3 months

· Fire extinguisher to be serviced for 2022 (observed charged).

· Follow up with North Bay Regional Center to obtain client's records needed for the facility file.

Exit interview conducted with Licensee, whose signature on this document confirms receipt. No deficiencies cited during this inspection