Facility Evaluation Report

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with S4 and the purpose of the visit was discussed. Administrator, Mary Gonzales arrived shortly after and the purpose of the visit was discussed.

The initial annual visit was conducted on 01/10/2025. During the initial visit the following five (5) Compliance and Regulatory Enforcement (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, and Personnel Records-Training.

During today’s annual visit, the following seven (7) Compliance and Regulatory Enforcement (CARE) tool domains were observed and reviewed: Client Rights-Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention.

Client Rights-Information: Facility does not have any clients requiring postural supports. Client personal rights and House Rules are posted. Per Facility Administrator, facility provides wi-fi services to all clients.

Client Records-Incident Reports: LPA reviewed Client files for Client #1 (C1) through Client #4 (C4). Client files are maintained at the facility and have the following documents in their files - Admission Agreements, Emergency and Identification Information, Face sheet, Physician's Report (including T.B and Ambulatory Status), Weight log, Client Medication Destruction Record, Appraisal Needs and Services Plan, Functional Capabilities Assessment, Client Personal Property, Client Cash Resources, and Clients Personal Rights. LPA also reviewed all client's P & I.