Facility Evaluation Report

On this day, February 6, 2025, at 11:30 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Assistant Administrator/House Manager (ADHM) Lilibeth 'Beth' Toco, and informed the reason for visit. LPA also met with other staff, Benjamin Fonacier. LPA called and let message on Yuka Ono's, licensee-administrator, voicemail.

LPA toured the facility inside out with ADHM. LPA inspected the kitchen, dining area, living room, bedrooms, play room, bathrooms, side yard and backyard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications and sharps were observed locked.

Facility has 2 in 1 carbon monoxide and smoke detector that was tested, and observed functional. Fire extinguisher checked, observed fully charge and receipt showed purchased October 15, 2024. Facility conducts fire drills and records showed last conducted February 2, 2025. Hot water temperature in one of the bathrooms was tested.

LPA reviewed 5 staff and 5 residents records. Medications were checked and compared with doctor's order and LIC622 Centrally Stored Medication and Destruction Record. P&Is were checked and compared with the last recorded balance.

-at 11:55 am, hot water temperature at 130.5 degrees Fahrenheit. This is a repeat violation within 12 month period. A citation was issued on February 8, 2024.

-at 2:30 pm, resident (R1) has order for Pravastatin Sodium (20 mg) on LIC602 Physician's Report dated 5/30/24, however, medication in the facility is Rosuvastatin Calcium 5 mg.