Facility Evaluation Report
Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Raquel Cistac, House Manager. 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 Raquel Cistac, House Manager. A screening station was observed at front entrance of facility which had hand sanitizer, a non-touch thermometer, and a sign-in sheet for visitors and staff. LPA was screened for COVID-19 symptoms and temperature was taken. Visitors are screened for COVID-19 symptoms (including temperature check) upon arrival to the facility. Staff verify visitor's vaccination status and a negative COVID test per PIN 22-04-ASC and State Public Health Officer Order dated 12/31/2021 (LPA verified documentation).
Staff and resident's temperatures are taken daily. Staff clean and disinfect the facility throughout the day. The facility has a supply of PPE including gloves, face shields, N-95 respirators, surgical masks and disposable gowns. LPA observed COVID-19 precaution postings, liquid hand soap and paper towels available in bathrooms. 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 observed 2 residents in care. House Manger wore masks during this visit.
LPA discussed the following CCL requirements with Raquel Cistac :
· Staff training documented in the following areas: infection prevention, symptoms, transmission and PPE use
· N-95 respirator Fit testing (Cal/OSHA requirement) for staff.
The following forms were requested to update the facility administrator (to be submitted to CCL by 02/11/2022): LIC215, LIC500, LIC308, LIC501, copy of Administrator’s certificate
Exit interview conducted with house Manger, whose signature on this document confirms receipt. No deficiencies cited during this inspection
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction