Facility Evaluation Report

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

The following domains of the CARE Inspection Tool was reviewed on today's visit: Infection Control, Physical Plant & Environmental Safety, Food Service, Health Related Services, Incidental Medical Services, Disaster Preparedness. The common areas and the following resident rooms were inspected together with Stephen. Manalo: Room #102, Room #107, Room #110, Room #115, Room #122, Room #00. LPA attempted to inspect room #119 but was refused entry by the resident. The emergency food supply stored on the premises and at the skilled nursing facility was inspected during today's visit.

The following was observed during today's visit: all 6 resident rooms inspected are shared rooms and are furnished with 2 beds, 2 chairs, 3 wall lights - one over each bed and one in the center, a night stand, a chest of drawers/shared dresser, and a built in closet, The following deficiencies were also observed in the 6 bedrooms inspected:

Room #102 - the center wall light in bedroom was not operational.

Room #107 - one of the wall lamp was not operational, the window blinds were missing slats and the chest of drawers were broken. The water temperature tested in the bathroom read 122.5 degrees Fahrenheit..