Facility Evaluation Report

Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and was greeted by Licensee, Danilo Sy (DS). Administrator, Jayson Sy (JS) was contacted and arrived during the visit. The facility currently provides care for four (4) residents none of which with a diagnosis of dementia.

LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with Administrator and facility staff; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 5/10/2021 at the time of the visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are securely stored under kitchen and bathroom sinks and in the garage. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Hot water measured between 108.5 and 110.8 degrees F which is within Title 22 regulations of 105 to 120 degrees F in faucets used by residents.

During the tour LPA found that two (2) staff (S1 & S2) had fingerprint background clearance but were not properly associated to the facility. LPA has copies of Background Check Clearance documentation for S1 & S2. Administrator to immediately contact appropriate Department agency and associate staff to facility.