Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Claudia Tejeda (Caregiver Supervisor), sortly after Administrator Brandie Mendibles and Assistant Administrator Jason Perez arrived and assisted with the visit, the purpose for today’s visit was explained. The facility is licensed to serve 252 Non-Ambulatory Residents ages 60 and over (of which 5 may be bedridden in rooms #136,#102,#103, #104 and #112). The facility has an approved Hospice Waiver on file for thirty (30) residents.

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

Infection Control: The facility staff are using appropriate hand hygiene and cleaning/disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan.

Operational Requirements: The facility has an approved fire clearance, there is a plan of operation with required Infection Control Plan, Dementia Plan and training. Facility maintains the required liability insurance and Surety Bond.

Physical Plant & Environment Safety: LPA toured facility, a total of 10 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 that were tested an 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 are two shaded patio/garden areas for residents one within the memory care wing and the other in the assisted living area. (continued on LIC809-C)