Facility Evaluation Report

On 11/15/2024 at approximately 11:00am an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan. Upon arrival, LPA met with the caregiver Rose Hugal, who granted access to the facility. LPA explained the reason for the visit. Shortly after the Administrator, Mary Jane Garner arrived and helped with physical plant tour and staff/residents files.

During today's visit, LPA conducted a physical plant walk through, at approximately 11:30am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22.

The facility is a single-story home and is licensed for capacity of six (6) residents, of which five (5) may be Non-Ambulatory and one (1) bedridden for bedroom #2. Facility also has a hospice waiver for one (1) resident. There are five (5) bedrooms in the facility of which four (4) are designated for residents’ use. All bedrooms observed to be appropriately furnished except bedroom #4 had broken furniture/chest. All bedrooms have appropriate lighting. There are three (3) bathrooms in the facility of which two (2) are designated for residents’ use. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 11:45 to be 107°F. Extra towels and linens were readily available. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination.

LPA observed facility alarms were off on all exit doors.

SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 1:00pm they were tested and observed to be operational. The facility has two (2) fire extinguishers that were last purchased on May 3rd, 2024.