Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Administrator Ana Giron and explained the purpose for today’s visit. The facility is licensed to serve 150 Ambulatory Elderly Residents ages 60 and above, of which 70 may be Non-Ambulatory. Facility holds a hospice waiver for up to 5 Residents. (there are currently 1 resident utilizing hospice services)

The Facility is a 2 story building located in Downey, CA. A tour of the facility included: 1st floor : Multiple resident rooms with private full bath, Kitchen, Dining Area, Laundry Room, Storage Closets (for cleaning/janitorial supplies), TV Room, Medication Room, Staff Restroom, Staff Office, Lobby, Reception Area, Staff Break Room, and Outdoor Patio. 2nd floor: Multiple resident rooms with private full bath, Doctor Room, Staff Restroom, and Library. There is one elevator that LPA observed to be in working condition.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today:

Infection Control: Facility has sufficient PPE supplies and maintain the required Infection Control Plan.

Operational Requirements: The facility has an approved fire clearance, there is a plan of operation with Hospice Plan and training. Facility maintains the required liability insurance with expiration date of 4/1/26.

Physical Plant & Environment Safety: LPA toured facility, a total of 8 residents’ bedrooms/units were checked and had the required closet/drawer space to accommodate each resident comfortably available. The resident rooms have signal systems located in each bathroom and in bedroom that were tested and operating properly. There are smoke detectors, carbon monoxide detectors and an emergency sprinkler system throughout the facility that are operable and in compliance. The fire extinguishers were observed throughout the facility and are fully charged. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available. The hot water temperature was tested throughout the facility resident private bathrooms and measured within the required range of 105-120 degrees. There is a large shaded patio area on the first floor for residents. (Continued on LIC809-C)