Facility Evaluation Report

Licensing Program Analyst (LPA Luisa Fontanilla arrived unannounced to conduct an annual required inspection. LPA was met by staff Leonora Maquilan. LPA explained to staff the purpose of the visit. Administrator Marvin Tom was informed about the visit via telephone. Administrator arrived at approximately 12 noon.

During the visit, LPA inspected the facility inside and out including but not limited to bedrooms, bathroom, kitchen, dining area, garage and backyard. Hot water in the kitchen measured at 109.7 Fahrenheit. A fire extinguisher that appeared full and last inspected on September 2023 was observed. Smoke detectors and carbon monoxide were tested and observed operational. First aid kit was reviewed and observed complete.

At 11:15am, LPA reviewed 5 resident files and 4 staff files. At 3:10 pm, LPA interviewed 2 staff.

The following deficiencies were observed:

windows were observed with cobwebs/mold on window frame/certain screen windows with holes

R5 is diabetic and on insulin but unable to manage own insulin and no approved exception

S3 has Dementia; last Physician's Report date is 11/15/2021

No Resident Rights, Non discrimination and Resident Family Council posters

The following records will need to be submitted to CCL by Monday, 1/29/24: Emergency Disaster Plan, Lic 500, Resident Roster and Disaster Drill.

Deficiencies are cited per Title 22 California Code of Regulations (refer to Lic 809D).

Exit interview was conducted and Appeal Rights was provided