Facility Evaluation Report

Licensing Program Analysts (LPAs), Mayra Cota and Blanca Gonzalez, conducted an unannounced required annual visit. LPAs met with Marianela Campos, Caregiver and explained the reason for the visit and she assisted LPAs with the tour of the facility. Km Dhammike Keerthisnghe, Administrator, arrived shortly after.

The facility is licensed to serve six (6) non-ambulatory of which two (2) may be bed-ridden. Waiver granted for Hospice Care for six (6). The facility is operating within the scope of its license. Facility is in a residential area of Downey.

During the visit, LPAs toured the facility's indoor and outdoor environment, reviewed three (3) resident and (3) staff files, and conducted medication review. The facility is a single-story house which consists of a receiving area, office area, living room/dining area, kitchen/laundry closet, two (2) private resident bedrooms, two (2) shared resident bedrooms, one (1) staff bedroom, three (3) bathrooms, front and backyard and detached garage.

During today’s visit, LPAs observed the following:

Living room and dining area were observed clean and furniture is in good repair.

Resident bedrooms have the required furniture such as dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen and mattress pads. Bed rails have the required physician orders in place. Rooms housing oxygen tanks have the required signs posted on the doors. Resident oxygen tanks have the proper stands and extra tanks are stored properly.