Facility Evaluation Report

License Program Analyst (LPA) Jill Nakagawa (JN) arrived unannounced to conduct a Required 1-year visit of the facility on December 17, 2021 at approximately 11:40 AM. LPA was welcomed by Reinalda Lopez (RL), DSP Staff, who toured LPA throughout the facility. Administrator, Freddie Diaz was consulted via phone regarding the Infection Control Inspection. There are 4 clients/residents at the facility.

The facility has 4 resident bedrooms. There are two bathrooms: one for residents/clients and one for staff. They were clean and had a supply of soap and paper towels, as well as postings of instructions for hand-washing. Toxic cleaning supplies are stored in a locked closet located by the Family Room and in the Office. Perishable and nonperishable food supplies were sufficient to Title 22 Regulations of 2 days of perishable and 7 days of nonperishable. Knives are kept locked in office closet. The kitchen and dining area were organized and free of clutter. The facility was a comfortable 72 degrees. The facility was clean and well maintained. There is a re-purposed garage used for client activities. A dining room/seating area located off the kitchen which is used by 1-2 residents or staff at a time.

The facility has a locked medication cupboard which is kept in the office, which is also locked. The Facility has a multi pull station fire alarm with audible/visual notification. Facility has 8 operational smoke detectors, one operational carbon monoxide detector and one fire extinguisher which is charged and dated July 16, 2021.

Facility has submitted a Mitigation Plan, approved on 05/05/2021. There is a single entry/ check-in station at the front door, with screening questions and temperature checks. Temperatures and symptom checks are documented daily for staff, residents and visitors.

Facility has PPE supply stored in a locked closet.

No deficiencies during today's inspection.

Exit interview conducted with the DSP RL.