Facility Evaluation Report

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

LPA toured the facility, all exits were unobstructed. Fire extinguisher was charged and serviced 04/12/2022. LPA observed a screening station complete with a sign-in sheet, COVID-19 screening questionnaire, thermometer, and hand sanitizer. The facility has an ample supply of PPE including gloves, hand sanitizer, N-95 respirators, gowns, face shields, and surgical masks. Staff and client's temperatures are taken daily and documented. Staff have received refresher training's on 06/10/2022 on the following: proper utilization of PPE, infection prevention & control (IPC), and environmental cleaning & disinfection to prevent COVID-19 and other infectious/communicable diseases. Staff have current CPR/first aid certifications in file. During this visit, LPA verified staff COVID-19 vaccination records. Designated staff have completed N-95 Fit Testing (Cal/OSHA requirement) and have documentation in file. LPA discussed with administrator the facility's current fire clearance (approved for 4 ambulatory only) and medication storage. All staff wore masks during this visit.

LPA requested the following updated forms to be submitted to Community Care Licensing by 01/05/2023:

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

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

· LIC 9020 Register of Facility Residents/clients

· Copy of current Administrator's Certificate

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

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