Facility Evaluation Report

On 5/19/2025 at 9:45AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with caregiver, Remedios Manalang and explained the purpose of the visit.

LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, and outdoor area. Smoke and carbon monoxide detectors were observed. Sprinkler system observed. Fire extinguisher was observed to be full and last serviced on 6/5/2024. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 111 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mats in the bathrooms. Resident rooms were observed to be cleaned and fully furnished. First Aid kit is complete. LPA reviewed 5 residents and 4 staff files starting at 11:00AM. LPA reviewed a sample of resident's medications during inspection. LPA interviewed 2 residents and 2 staff during inspection.

At 2:00PM, LPA observed R1's MAR states vitamin D3 was 5,000 units and the bottle shows vitamin D3 was 1,000 units. Doctor's order for R1's vitamin D3 was not on file.

At 2:10PM, LPA observed R1's centrally stored medication and destruction records was incomplete and did not include some of R1's medications.

The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights were provided.