Facility Evaluation Report

Licensing Program Analyst (LPA) KaSandra Lopez an unannounced Required -1 Year inspection. The LPA arrived at 11:23 AM and met with staff Nicole Cortes and explained the reason for today's inspection. The home is vendored by Tri-Counties Regional Center as a level 2 home. At 11:25 AM, the LPA spoke with Licensee Floro Cortes on the telephone and advised that he still needs to submit an updated LIC 200 and new administrator information for this home due to the passing of the other Partner/Licensee. The Licensee agreed to submit this information as soon as possible.

The LPA, along with the staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. This Required - 1 Year inspection has a specific emphasis on infection control practices and procedures.

Kitchen The kitchen and food storage areas were observed. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Cleaning supplies and medications are stored in locked cabinets.

Common Areas: The living room was furnished appropriately. The two fire extinguishers were fully charged and last serviced on 09/30/2021. Infection control signs are posted through out the facility. The facility has one common and one private restroom for resident use. Restrooms were observed to be clean and sanitary with hand soap and napkins. At 11:43 AM the hot water temperature was tested in the common hallway restroom and it measured at 109.4 degrees F. The backyard has seating for resident use. The carbon monoxide detector and smoke alarms in the common areas and bedrooms were tested at 11:53 AM and were found to be operational.

Bedrooms: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Report continued on LIC 809-C.