Facility Evaluation Report

On 8/27/2024 at 9:00AM, Licensing Program Analysts (LPAs) G. Luk and P. Manalo arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Executive Director, Eunice O'Farrell and explained the purpose of the visit.

LPAs toured the facility including but not limited to bedrooms, bathrooms, dining area, activity room, kitchen, common areas, and outdoor area. Centrally stored medications were locked in different carts located in the med room. First Aid kit is complete. The facility has a written emergency disaster plan. Smoke detectors were interconnected with sprinkler system. Carbon monoxide detector was observed. Fire extinguishers were observed to be full and last serviced on 2/13/2024. One week supply of nonperishable and 2-day supply of perishable foods were available. Facility orders food supplies once a week. Freezer’s temperature was registered at -2 degree F while the refrigerator’s temperature was recorded at 36 degrees F. Hot water temperature was measured at 111.1 degrees F in a resident's bathroom sink. Grab bars and non-skid mat/materials were observed. There were adequate lights in each room. Indoor and outdoor passages were free of obstruction. Last fire drill was conducted on 6/13/2024.

LPAs reviewed 5 residents and 5 staff files starting at 10:25AM. LPAs interviewed 3 residents and 3 staff starting at 2:00PM. LPA reviewed a sample of resident's medications starting at 3:00PM.

At 12:30PM, LPAs observed S3 did not have current annual training completed.

At 3:30PM, LPAs observed S6 was not fingerprint cleared. LPAs reviewed Guardian system and observed S6's determination status was "closed - incomplete application".

The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and Health & Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report, civil penalty, and appeal rights were provided.