Facility Evaluation Report

On this day at around 9:15 am, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a continuation annual required inspection. LPA met with Co-Administrator, Paula Madrigal. LPA was informed by Co-Administrator that Administrator, Juliet was out of town, and will return 5/17/24.

The following deficiencies were observed:

· at around 9:30am, LPA reviewed facility files (liability insurance expired on 2/2/22).

· at around 9:40am, LPA reviewed facility files (emergency disaster plan is not up to date).

· at around 10:00am, LPA reviewed facility files (there are no record of fire trill).

· at around 10:10am, LPA reviewed facility files (facility do not have designation of administrative and staff assignments on files)

· at around 10:20am, LPA reviewed resident’s files (not having PRN medication signed, dated written order from a physician).

· At around 11:35am, LPA observed the storage room in the garage are being used for staff bedroom.

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

Exit interview was conducted and Appeal Rights was provided to Co-Administrator Paula Madrigal.