Facility Evaluation Report

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Administrator, Meynard B Villa who assisted with the visit. The facility has a capacity of six (6) residents to serve elderly residents age 60 and above, approved for six (6) non-ambulatory, of which one (1) may be bedridden. Facility approved for two (2) hospice waivers. Bedroom #5 is cleared for bedridden. Annual fees are current. There were two (2) hospice residents residing at the facility.

LPA conducted the inspection by using CARE tool, interviewing staff/residents, conducting physical plant, and checking food supply/medications.

The facility is a single-story home consisted of five (5) resident’s bedrooms, four (4) bathrooms, living room, den, kitchen, dining room, activity area at the patio, laundry room and detached garage. The facility was located in a residential neighborhood. Residents’ rooms were well furnished and in compliance. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature measured at 119.4 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. Facility maintained a comfortable temperature for residents. Auditory alarm devices to monitor exits were operable. Sufficient supply of perishable and nonperishable food is observed. Dual smoke detectors with carbon monoxide detectors were operable, monitored by fire prevention company ADT and wired to fire department. The outdoor activity area has a shaded patio with ample seating. Medication are centrally stored in a locked cabinet in the kitchen and inaccessible to residents. Resident records are stored in a locked cabinet and inaccessible to residents.

No deficiency was observed and cited per California Code of Regulations, Title 22. An exit interview was conducted. This report is discussed and provided to Meynard Licensee /Administrator.