Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct a Annual Required - 1 Year inspection and met with Selene Cruz-Astroga, Administrator . The annual inspection is focused on the Infection Control procedures and practices of this Enhanced Behavioral Supports Home - Adult Residential Facility.

LPA toured the facility, all exits were unobstructed, and the facility was found to be clean & at a comfortable temperature. Facility has a COVID-19 screening station (visitor sign-in sheet, COVID questionnaire, thermometer, hand sanitizer). Staff have current CPR/first aid certifications in file. Fire extinguisher was charged. 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. The facility has submitted their Infection Control Plan to the California Department of Social Services, Community Care Licensing. Staff have received refresher training on Proper Utilization of PPE, Infection Prevention & Control, and Environmental Cleaning to Prevent COVID-19 and other Infectious Diseases from Solano County Public Health on 07/14/2022 . During this visit, LPA verified staff COVID-19 vaccination records. LPA verified documentation on N-95 Respirator FIT testing for staff (Cal/OSHA requirement) was completed.

All staff wore face masks during this visit.

LPA requested the following updated forms to be submitted to Community Care Licensing by 11/17/2022:

· 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