Facility Evaluation Report

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Post Licensing Inspection and met with Staff Member Lupo Canilao, Administrator was not present.

Upon arrival, LPA temperature was checked and documented and LPA was asked to sign in. LPA conducted a walk-through of the facility and observed the following: Facility has Covid-19 posters throughout the facility, LPA removed a notice that was observed in the front door that stated the facility required any visitor to be Covid tested prior to entering. LPA observed hand washing signs in the bathroom. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer was available in common areas. Staff wear masks while in the facility. Observed staff had mask on during this visit.

LPA observed the facility is not providing any activities and this was confirmed with 2 of 5 residents. Commonly touched surfaces are disinfected daily or as needed.

Facility has at least a 30 day supply of Personal Protective Equipment (PPE) including surgical masks, gloves and hand sanitizer.

Facility failed to have correct or an admission agreement in file for 2 of residents and preadmission medical assessment for resident R2

During today's visit there was no evidence of staff having CPR/1st aid, but facility stated the training was current and will provide proof to LPA Canela.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Appeal rights read and emailed to facility.