Facility Evaluation Report

This is an amendment of the original report issued 09/03/2024. Based on 2 nd level appeal response deficiencies 87705(c)(4) and 87204(a) have been dismissed.

Licensing Program Analyst (LPA) Lorena Casillas met with administrator Monica Gory for an unannounced one (1) year Required visit for this facility.

LPA arrived at 10:00 am and was greeted by a caregiver. Caregiver called administrator and LPA was informed that administrator was on their way. LPA informed the Administrator of the purpose of the visit via phone. Six (6) out of the six (6) residents were observed to be in their room sleeping, watching TV and/or resting. There is only one (1) staff member for care in the facility. The Administrator arrived at 02:45 pm.

Infection control: LPA previously reviewed the facility mitigation plan (approved on 03/ 1 8/21) to make sure the licensee was following current infection control recommendations.

A tour of the physical plant was conducted with caregiver at 10:20 am. The facility has five (5) bedrooms and two (2) bathrooms currently occupying six (6) residents. One (1) bedroom is designated for staff use only. The facility is Fire Cleared for four (4) ambulatory, two (2) non-ambulatory, and a hospice waiver for one (1). Currently the facility has no residents on hospice.

Food Inspection: LPA conducted a tour of the kitchen 10:20 am and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas care clean and inaccessible to pests. LPA observed all knives and sharp objects being locked and inaccessible to residents in care. The Medication cabinet was in the kitchen and was observed to be locked and inaccessible to residents in care.