Facility Evaluation Report

Licensing Program Analyst (LPA) Nune Margaryan conducted an Annual Required visit and inspection of the facility. LPA met with Francisco Moreno, Administrator and explained the purpose of the visit. During the visit , the CARE tool was used. The facility is licensed to serve six (6) non ambulatory residents of which one (1) may be bedridden. Hospice waiver granted for four (4) residents and currently 2 residents on hospice. At the time of visit 1 resident was at the Hospital for evaluation.

The facility is a single-story home, located in a residential area, that consists of a living area, dining area, four (4) resident bedrooms, two (2) bathrooms ( 1 for staff and 1 for residents), a kitchen, detached garage/ storage room. LPA toured the facility. All indoor and outdoor passageways were free of obstruction. The front and backyard are well maintained and there are no pools or large bodies of water. All rooms were properly furnished with appropriate beddings and linens with sufficient lighting. The hot water temperature was tested and was measured within Title 22 Regulation guidelines. Grab bar and non-slip mat was observed in the bathroom bathing area. Common areas included the living room and dining area were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Facility wall thermostat was set at 74.0°F and observed to be within the required range. LPA observed detached garage/ storage room. Laundry located in the garage. There is second refrigerator in the garage. Garage/Storage door is locked. The front and backyard are well maintained and there are no pools or large bodies of water. Passageways and exits are free of obstruction. LPA observed shaded seating areas in the front of the house. Carbon monoxide detectors are present at the facility and residents bedrooms. They are tested and were operational during the visit. The kitchen was inspected. There is sufficient perishable and non-perishable food. All the appliances are clean and working properly. Sharps are locked and are inaccessible to residents. LPA observed plenty linens, towels in the linen closet in the dining room. Fire extinguisher observed in the facility fully charged. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. LPA reviewed residents and staff files. LPA confirmed staff working have fingerprint clearances. LPA reviewed residents medications. Medications are documented properly and given as prescribed.

No deficiency was observed during today's visit. Exit interview was conducted and a copy of report was provided to Administrator.