Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Administrator Victoria Tran and explained the purpose for today’s visit. The facility is licensed to serve 75 Non-Ambulatory residents of which 10 may be bedridden. Approved bedridden rooms #2, 4, 5, 6, 7, 8, 9, 10, 11, and 12. Approved hospice waiver for 10 residents. There is currently 1 resident using hospice services and 0 bedridden.

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

Infection Control: The facility maintains the required Infection Control Plan.

Operational Requirements: The facility maintains the required liability insurance.

Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms/units were checked and had the required closet/drawer space to accommodate each resident comfortably available. The resident rooms have signal systems located in each bathroom that were tested an operating properly. There are smoke detectors, carbon monoxide detectors and an emergency sprinkler system throughout the facility that are operable and in compliance. The fire extinguishers were observed throughout the facility and are fully charged. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available. The hot water temperature was tested throughout the facility resident private bathrooms and measured within the required range of 105-120 degrees. Facility has shaded patio/garden areas for residents on each floor.

Staffing : There appears to be sufficient staffing at all times in the facility.

Personnel Records-Training : Staff have criminal record clearance, current First-Aid training along with training in postural supports, Alzheimer’s and Dementia, Hospice, care for Bedridden residents, medication assistance, and other ongoing training are documented in personnel files. LPA reviewed 5 staff files with no issues observed. Administrator Victoria Tran certificate expires on 4/15/2027 . (Continued on LIC9099-C)