Facility Evaluation Report

On 01/20/2024 Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Shirley Tudence and explained the purpose of the visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate. There are currently 4 residents who reside at this facility. The LPA Martinez toured the facility with Shirley Tuvedence on 06/20/2024 at 10:00 AM.

LPA Martinez reviewed two client files and two staff files, which files were maintained. The facility has an infection control plan and natural disaster plan. LPA Martinez requested a copy of liability insurance and surety bond. Facility staff agreed to email documents by 06/24/2024 by 5:00 PM. The facility Last fire drill was on May 10, 2024. LPA Martinez reviewed two medication administration records (MAR), and the records were maintained. The facility has a first aid kit. LPA Martinez reviewed two PNI ledgers, and both ledgers were maintained. The facility water temperature measured at 108 degrees, and the facility temperature measured at 75 degrees. The facility has an adequate food supply, and the kitchen was sanitary. Client bedrooms, bathrooms, common areas were furnished and sanitary. The facility fire extinguisher tags were not maintained, and LPA requested a fire inspection report. Facility staff were not able to provide documentation during the annual inspection visit. The fire extinguisher tag located at the kitchen indicated the last inspection was on December 22, 2022. In addition, the fire extinguisher located in the garage did not have an inspection date on the inspection tag. The fire inspection tag also reported the manufacture date was 2023. LPA Martinez reviewed the back side of the kitchen fire extinguisher tag, and facility staff signed off on the monthly inspection record section. The last staff fire extinguisher inspection was on June 07, 2024. However, facility staff did not have the fire extinguisher inspected by a professional fire inspection/testing company. Continued...