Facility Evaluation Report

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct an annual Required-1 year inspection and met with, facility nurse, Laverne Cabalquinto. Administrator was not available during this visit. The annual inspection is focused on the Infection Control procedures and practices of this Adult Residential Facility. There are currently 4 non ambulatory clients in care, no bedridden approval.

LPA toured facility and grounds with Laverne Cabalquinto and observed COVID-19 precaution signs posted in common areas to promote hand washing, wearing a mask and cough etiquette. Visitors are screened for COVID-19 symptoms upon arrival to the facility. Infection control practices are present: entry procedures, face coverings, daily monitoring and temperatures checked for staff, and clients and facility has 30-day PPE supply. Facility will follow indoor visitation requirement of verifying and tracking COVID-19 vaccination or verify non-essential visitors have proof of a negative COVID-19 test. Facility states staff clean and disinfect the facility daily. Bathrooms are equipped with liquid soap and paper towels. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher were found to be last charged and serviced on 9/21/2021.

LPA also requested the following updated records to be submitted to Community Care Licensing by 9/9/2022

· LIC 308 Designation of Facility Responsibility

· LIC 400 Affidavit Regarding Client/Resident Cash Resources

Exit interview conducted with Laverne Cabalquinto

N o deficiencies cited during today's Annual Required 1 YR inspection