Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met Caregiver Glenn Oriemo at approximately 8:15 AM and explained reason for visit. Administrator Jenine Palomares and Licensee Thang Duong were both out of town.

The facility is licensed to serve 6 non-ambulatory residents (age range from 60 years old and over), including 1 bedridden. Facility has hospice care waiver for 4 residents. The facility is a single-story home located in a residential neighborhood consist of 5 resident's bedrooms ,1 staff room, 2 bathrooms, a living room, a dining area, kitchen, laundry area in the garage, a garage, and an outdoor activity area at the backyard.

All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. R2 had bed rails with no physician’s order on file. Smoke detectors/carbon monoxide detectors were observed in each room and throughout facility. The facility has one (1) fire extinguisher that is fully charged in kitchen. Cleaning supplies and toxic substances are inaccessible locked in hallway closet. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. There are no firearms or weapons stored at the facility The resident bathrooms have the required grabs bars and non-skid mats. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The common areas include the living room and dining area are clean and have the required furniture. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents in back yard. Passageways and exits are free of obstruction. LPA observed an unpermitted room addition along with a full side bed and dressers in garage.