Routine inspection·June 6, 2022

Licensing Program Analyst Jose Villalobos conducted an unannounced Annual Inspection for Domain focused on Inspection Control. LPA was assisted by Administrator Levita Maghirang. As a part of the inspection, LPA used the inspection tool, reviewed (3) client records, (3) staff files, and (3) client medications. Currently the facility has (3) clients of which (3) are non-ambulatory. 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. 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. Food Supply was 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. Infection control domain completed and there were no deficiencies. An exit interview was conducted and a copy of this report was provided to Administrator Levita Maghirang.