Facility Evaluation Report

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced at approximately 9:40 AM on 10/13/22 at facility to conduct an Annual Inspection focusing on Infection Control. LPA was welcomed by Reina Lopez (RL), DSP II Staff, who toured LPA throughout the facility. Administrator, Freddie Diaz was consulted via phone regarding the Infection Control Inspection. There are 4 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 kitchen drawer. The kitchen and dining area were organized and free of clutter. The facility was a comfortable 73 degrees. The facility was clean and well maintained. The re-purposed garage used for resident activities such as exercise and arts and crafts. LPA was shown some wonderful painting projects done by residents.

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 12, 2022.

Facility has submitted a Mitigation Plan, approved on 05/05/2021. Facility has also submitted the Infection Control Plan. There is a single entry/ check-in station at the front door, with temperature checks for staff and visitors. Temperatures and symptom checks are taken each morning at residents' medication administration.

No deficiencies during today's inspection.

Exit interview conducted with the DSP II RL.