Facility Evaluation Report

At 9:30AM Licensing Program Analyst (LPA), Antonia Alvizar conducted an announced Pre-Licensing visit to the above facility and met with Administrator Elizabeth S Romero, Operations Director Joanne Olalia and Licensee Ann Seisa.

Fire Clearance was approved on 08/16/2023 for a maximum capacity of six (6) residents, of which six (6) non-Ambulatory and hospice waiver approved for six (6) residents. The purpose of today’s visit is to inspect the facility to ensure that the physical plant is in compliance with rules and regulations of California Code of Regulations, Title 22, Division 6, Chapter 8. The facility is a single-story building. During today’s visit at 9:55AM LPA inspected the physical plant inside and outside and observed the following:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, two (2) sinks, and microwave oven. LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents. Fire Extinguishers were dated 05/23/23.

LAUNDRY ROOM: The laundry room is located outside the home divided with a lock door in the porch area. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use.

BEDROOMS: There are six (6) bedrooms designated for residents use and one (1) staff bedroom. All resident bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational.

BATHROOMS: At 10:30AM LPA inspected the bathrooms they are clean and in excellent condition. LPA observed two (2) bathrooms with grab bar and non-skid mats for residents to use and one (1) staff bathroom. Water temperature was within regulation. LPA also observed sufficient quantity of toilet papers, soap and paper towels.