Facility Evaluation Report

Licensing Program Analyst's (LPA's) Vasallo and Mora conducted an annual continuation visit. LPA's met with Santos Valencia, caregiver. Administrator, Rafael Diaz was called and notified of the visit. The initial annual visit was conducted on 9/10/21. During the initial visit LPA's used the infection control tool to inspect the facility. LPA's toured the facility and observed 6 residents in care and 2 staff. The kitchen was toured. All appliances are working properly and there is sufficient perishable and non-perishable food. Bathrooms have the required grabs and the hot water was between 115 - 118 degrees.

During today's visit LPA's continued the infection control tool and reviewed staff and resident records, resident medications and infection control procedures. 5 resident files were reviewed to confirm emergency contact is updated. Resident #1 (R1) and Resident #2 (R2) did not have emergency contact on file. LPA's also reviewed 3 staff files to confirm health screenings and fingerprint clearances. LPA's reviewed 6 residents' medications. Resident #3's (R3) record did not include Quetiapine Fumarate 50 mg and Simvastatin 20 mg medication. Resident #2's (R2) record did not include Hydrocodone 325 mg and Escitalopram 20 mg medication. Resident #4 (R4), Resident #5 (R5), Resident #6 (R6) did not have a list of medications, but had medication present in the facility.

Per California Code of Regulation Title 22, the deficiencies observed are documented on the attached 809D.

Exit interview held with administrator over the phone. A copy of the report was provided to caregivers along with appeal rights.