Facility Evaluation Report

On 08/28/2024 at 1:40P.M, Licensing Program Analysts (LPAs) P. Manalo and G. Luk arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Maria Fatima Lacsamana and explained the purpose of the visit. Administrator certificate is current (# 6037469735).

LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, and common area. The facility consists of 6 total bedrooms which 6 bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 110.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in observed during visit. Fire extinguisher was last serviced on 06/06/2024.

At 2:30 P.M, LPA reviewed 3 residents records. At 3:15 P.M, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility.

The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and Health & Safety Code. Failure to correct the deficiencies may result in civil penalties.

LPAs is requesting the following documents:

LIC 308 Designation of Administrative Responsibility

Exit interview conducted. A copy of this report and appeal rights were provided.