Facility Evaluation Report

On this date, 3/22/2022 LPA was met by Licensee, Kristyn Leyva and stated the purpose of the visit. A tour of the facility was conducted. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point used by staff and all visitors.

Facility observed clean with no obstruction or fire clearance issues. Hand sanitizer was readily available throughout the facility for residents, staff and visitors. Four (4) resident bedrooms are private, resident bedroom with two occupants have a minimum of 6 feet between beds.

Fire extinguisher present and has a service date of 1/12/22. Smoke detectors and carbon monoxide detectors present and observed operational during today's inspection.

LPA observed 7-day supply of non-perishable and a 2-day supply of perishable food available. All chemicals and PPE are secured in locked garage. Mitigation submitted to Department October 2021, a copy provided via e-mail to LPA during inspection visit. Kristyn Leyva also serves as facility Administrator certification #6042519735, expires 1/08/2024. CPR/First Aid expires 4/27/23.

LPA provided with Administrator Certificate, CPR card, staff schedule, LIC 610, and LIC 9020 during facility inspection.

No deficiencies were observed during today's inspection. Exit interview was conducted. Facility report signed on site. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed.