Facility Evaluation Report

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with Luz Brillantes and Elizabeth Mungcal and explained the purpose for todays visit. Prior to the visit LPA Wesley conducted a risk assessment for on-site inspections. The facility phone number is 562 404 7601.

The facility consist of four resident bedrooms, one staff bedroom, three bathrooms(one located in staff area), a living room, dining room, kitchen, a patio with umbrella/table/chairs, backyard with storage sheds, and an attached garage(office area, storage, additional food).

During the visit the Infection control domain was used and the following areas were observed/inspected: The facility had all postings at the front entrance, bathrooms, and throughout the facility. A Pre screening area with PPE supplies near the facility entrance.

LPA conducted a complete tour of the facility, and observe the supply of food. Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA observed one fire extinguisher in the kitchen/dining room area. The water temperature was tested and measured 116.9 degrees F.