Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and met with Licensee, Tony Guevarra and Administrator, Chis Guevarra. LPA/Licensee/Administrator reviewed PIN 22-05, 22-06, 22-07 and 22-09.

LPA arrived at the facility and attempted to had their temperature checked, but thermometer was not working then it was logged into a sign-in sheet. LPA observed that facility has posters on the front door indicating visitors about updated visitor's policy to protect residents in care. Once inside the facility, LPA observed that staff were wearing masks during this visit. LPA/Administrator conducted a walk-through of the facility and observed Covid-19 posters that included hand washing signs. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer were observed in the common area of the facility. Facility bathroom are kept stocked with hand hygiene products. Commonly touched surfaces are disinfected at least once a day. Facility has designated an outdoor area for visitation. Facility is able to accommodate a single room for each resident that needs to isolate and is able to serve meals and deliver medications. Facility staff have been trained on PPE protocols and N-95 fit tested. Based on records review, staff and residents had not being monitored daily and results are not documented since May 2021. Facility maintains a 30 day supply of medication. Facility has a 100% vaccination rate. However, not all of them have received boosters. Clients do not typically wear a mask while in the facility, but they do wear masks when in the community. Clients do not attend to wellness program due to covid19 restrictions but they do other activities at the facility. Clients do not receive indoor visitation just outdoors. Facility has submitted their Covid Mitigation Plan and approved on 7/14/21. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including masks, face shields and hand sanitizer. PPE supplies are located in an accessible place for staff.

Licensee agreed to provide updates of the following by 2/25/22: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), affidavit regarding client/resident cash resources (LIC400), surety bond

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.