Facility Evaluation Report

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

LPA conducted a tour of the facility which was observed clean and at a comfortable temperature. All exits were unobstructed. The facility has a screening station (hand sanitizer, a thermometer, COVID questionnaire, and a sign-in sheet for visitors and staff). LPA was screened for COVID-19 symptoms and temperature was taken and documented. Staff verify visitor's vaccination status or a negative COVID test as required for indoor visitation. Staff clean and disinfect the facility and high touched surface areas 2 - 3 times daily. The facility has a designated visitation area, provides virtual visits and phone calls for visitors to stay in contact with clients. Client's temperatures are taken and documented once daily; facility began taking client temperatures 4 times a day as of 06/27/2022. Staff temperatures are taken once a day. LPA observed clients participating in activities. LPA observed COVID-19 precaution postings, liquid hand soap and paper towels available in bathrooms. Facility staff have completed training on PPE use, isolation policies, and infection prevention. N-95 respirator Fit testing for staff (Cal/OSHA requirement) has been completed, LPA observed documentation. LPA observed a supply of PPE including gloves, face shields, N-95 respirators, surgical masks and gowns. All staff wore a face masks during this visit. LPA verified staff's vaccination status for COVID-19; all staff have completed and have documentation in their files.

LPA requested the following updated forms to be submitted to Community Care Licensing by 07/13/2022:

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

· LIC 400 Affidavit Regarding Client/Resident Cash Resources

· LIC 9020 Register of Facility Residents

· Copy of current Administrator's Certificate

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

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