Facility Evaluation Report

Licensing Program Analyst(LPA) Christine Yee conducted a subsequent unannounced continuation Annual Inspection visit using the complete CARE Inspection Tool and met with Hector Gomez, Assistant Administrator. Also participating in today's visit was Stephen Manalo, Administrative Assistant. The reason for today's visit was explained.

The facility is a 2 story, large commercial building consisting of bedrooms number 100-125 (26 rooms) downstairs and bedrooms #201-203(3 rooms) upstairs, dining room, 2 common shower rooms and 2 half bathrooms downstairs and 1 full bathroom and a half bathroom upstairs. The facility is fire cleared for 58 NON-AMBULATORY residents.

The following 5 domains of the CARE Inspection Tool were reviewed on today's visit: Personnel Records-Training, Clients Rights - Info, Health Related Services, Client Rec-Incident Report and Emergency Intervention. Also reviewed were 5 resident files and 5 staff files. The following domains will be reviewed on a return visit: Physical Plant, Incidental Medical Service and Disaster Preparedness.

The following deficiencies were observed during today's visit:

Per review of Client #4 and #5's file, the administrator was not able to provide completed PRN Authorization letters for the PRN medications being taken by both clients.

Staff #6's file did not have evidence of a physical with the results of a TB test.

Per review of the first aid kit, no first aid manual was observed.

Per the initial visit conducted on 3/19/25, the clients' meals are prepared off-site and it was