Routine inspection·May 11, 2021

Licensing Program Analyst Jose Villalobos conducted an unannounced Annual Inspection for Domain focused on Inspection Control. LPA was assisted by administrator Levita Maghirang. The facility is licensed as a Residential Care Facility for the Elderly. The home is a (4) bedroom and (2) bathroom single story home located in a residential neighborhood. Facility is licensed for (6) residents of which (1) may be bedridden. The home was adequately furnished, including the dining room, living room, inside patio.. Bedrooms #1-2 are for 1 resident each. Rooms #3-4 are for up to (2) residents each. Each bedroom had the required, furniture, fixtures, equipment and supplies. Including complete set of bedding, linen supply, hygiene supply, storage space, lighting. The smoke detectors and the carbon monoxide detector were tested and are operational. Medications, cleaning solutions, toxins, knives are locked and inaccessible to clients. Hot water temperature measured within regulation. First aid kit observed. Activities were residents were social distanced were observed. Outside shaded activity area is available for resident use. Yard is free of debris. Exits and passageways are free of obstructions. Facility is following Covid-19 guidelines and recommendations. Mitigation plan was approved 5/1/2021. Files Reviewed: LPA Villalobos reviewed five (5) staff files and all had the following: Health screenings with TB information was also present. All staff files reviewed also had criminal record clearances and are associated to the facility. Five (5) staff files reviewed have current first aid certificates and proof of training on file. Health screenings with TB information was also present. One (1) resident file was reviewed at 1:20pm. File have complete needs and services plans. Resident have complete medical assessments with TB information. Admission agreements completed. Resident medications were randomly chosen for review. Medications are documented properly and given as prescribed. First Aid kit was fully stocked with current manual. The last disaster drill was conducted on 2/15/21. The facility's annual fees are current but are due soon. Administrator stated they would pay the fees today. No deficiencies were cited on todays visit. Exit interview was conducted with Administrator Levita Maghirang.