Facility Evaluation Report

Licensing Program Analyst (LPA), Alviso, conducted a Required- 1 Year visit, and met with Administrator John Wotring, 4/3/24 at approximately 1:00pm.

Facility has a required infection control plan. Facility has a required emergency disaster plan. Fire clearance approval is for twenty-five (25) non-ambulatory.

Facility provided lunch to residents in care. The exits were all cleared and unobstructed. The common areas had sufficient lighting for all residents use. Facility kitchen, activity areas, resident bathroom, conference area, staff offices, and staff bathroom, were observed to be clean and orderly. LPA observed staff interacting with residents in attendance, and activities inside and outside for the residents. Facility's fire extinguishers were serviced and tagged as required. Cleaners/disinfectants were locked up and inaccessible to residents in care.

LPA reviewed three (3) staff files. All files were complete. Staff have first aid/cpr certification. Staff have required criminal record clearance. LPA reviewed six resident files. All files were complete.

Licensee to submit the following annual forms by 5/3/24.

Emergency Disaster Plan- updated & reviewed as needed

LIC400-Affidavit Regarding Client Cash Resources

LIC402-Surety Bond (if handling client cash)

Infection Control Plan- updated & reviewed as needed