Facility Evaluation Report
On this day, November 16, 2023, at 12:25 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Adrian Escueta, administrator, and informed the reason for visit. LPA also met with Lina Lingat, staff. There were 3 residents in the facility when LPA arrived.
Facility has LIC808 Mitigation Plan but has not submitted the Infection Control Plan.
LPA toured the facility inside out. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, yard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked.
Facility has smoke and carbon monoxide detectors that were tested, and observed functional. Hot water temperature in one of the bathrooms was tested. Facility conducts disaster drills.
LPA reviewed 5 staff and 5 residents files, and interviewed 2 staff and 2 residents. Medications checked, and compared with records and doctor's orders. Residents P&I checked and compared with records.
The following current/updated documents to be submitted by November 30, 2023:
1. LIC308 Designation of Facility Responsibility
3. LIC610D Emergency Disaster Plan (9 pages)
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction