Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct annual required inspection. LPA was met by staff Margrethe Bautista who states Administrator is currently out of the country and will be back on 11/15/2023.

During the visit, LPA inspected the facility inside and out including but not limited to 3 resident rooms, bathroom, kitchen, dining, garage and backyard. Hot water in the kitchen measured at 120 degrees Fahrenheit. Smoke detector and carbon monoxide were tested and observed functional. Fire extinguisher was observed full and manufactured in 2023. There were sufficient food supplies observed. LPA observed ample supply of towels, sheets and linen.

LPA reviewed 3 resident and 2 staff files. LPA interviewed one staff and 2 residents. First aid kit was observed complete.

The following deficiencies were observed:

R2 has catheter but facility does not have an approved exception and no proof of staff training

S2 does not have First aid training, missing Lic 501, 503 and tb test

R3's bed was observed blocking exit door; extra bed in R3's room partially blocking doorway

backyard/sideyard were observed with empty boxes, tools, unused equipment etc, ;fence was observed leaning towards the next door neighbor

no updated Emergency Disaster Plan (plan on file is dated 2011)

medications observed unlocked in the kitchen

fruit flies observed hovering in the kitchen/dining area