Facility Evaluation Report

Licensing Program Analysts (LPAs) Elena Mallett and Cynthia Chan conducted the required annual inspection. LPA arrived unannounced and met with Licensee Percy Olidan and explained the purpose of the visit. License Program Manager(LPM) Fernando Fierros joined the visit shortly after. The facility is licensed to serve 6 Residents ages 60 and above, with a hospice waiver for (1) one. Currently 3 ambulatory residents live at the facility and none are receiving hospice care.

The facility is a single-story home located in a residential area in La Puente, Ca. A tour of the facility includes: 3 resident bedrooms, 3 staff rooms, 4 bathrooms, the one in the rear does not appear on the facility sketch. There is a kitchen, dining area, living room, staff office, front yard and back yard. There is an outdoor kitchen and a covered patio and a detached storage room. LPA observed storage room partially converted into a staff room that did not appear on facility sketch.

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

Operational Requirements: The facility has an approved fire clearance, there is a plan of operation with required Infection Control Plan. LPA observed the facility not to have current Liability insurance. A complete First Aid kit and manual was observed.