Facility Evaluation Report

On this day at around 9:35 am, Licensing Program Analysts (LPAs) L. Fontanilla and P. Manalo arrived unannounced to conduct an annual required inspection. LPAs met with Administrator Zenaida Bautista and explained the purpose of the visit.

During the visit, LPAs 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 144 degrees Fahrenheit. Smoke detector and carbon monoxide were tested and observed functional. Fire extinguisher was observed full and was purchased on 2/3/2024. There was sufficient supply of both perishable and non perishable foods. LPAs observed ample supply of towels, sheets, linen and hygiene products.

LPAs reviewed 2 resident and 3 staff files. LPAs interviewed two residents. First aid kit was observed complete. Facility has liability insurance. Last fire drill was conducted on 8/15/2024. Medications and Medication Administration Record (MAR) were reviewed.

Deficiencies were cited per Title 22 California Code of Regulations (see attached Lic 809D). Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

The following records were requested to be submitted to CCL by 11/21/2024: Lic 500, Roster of Residents, updated Emergency Disaster Plan, Liability Insurance.

Exit interview was conducted. A copy of the Appeal Rights and this report were provided.