Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with caregiver Ivy Ceraide and explained the purpose of today’s visit. Administrator Jojomaureli Salamero was notified by telephone.

Facility is licensed to serve Residents ages 60 and over. Approved fire clearance for 5 non-ambulatory, two (2) residents in room #1, two (2) residents in room #4, and one (1) resident in room #2. One (1) bedridden in room #3. Staff room #5 87705 compliant. Hospice waiver for 2 residents. The facility is single story house located in a residential neighborhood in the city of Palmdale. LPA toured the facilities physical plant, indoor and outdoor. The facility has a formal living room/dining room, four (4) resident bedrooms, one (1) staff room, two (2) bathrooms (one of which is in bedroom #1), kitchen with dining area and second living room, laundry area, and attached garage used for storage.

LPA toured the facility and observed the following: All resident bedrooms have the required furniture and bedding. There is extra clean linen and towels in hallway cabinets. Smoke detectors/carbon monoxide detectors were observed throughout facility. The facility has one (1) fire extinguisher which is kept in kitchen. LPA observed four kitchen chairs to all be torn. Cleaning supplies and toxic substances were observed to be accessible to residents in care in laundry area in top of washing machine. Sharps are locked in drawer in kitchen. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. LPA observed a box of unlocked comfort care medication in refrigerator. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured not between the required range of 105-120 degrees F. Bathroom #1 127.3 and bathroom #2 125.6. There is a broken bar in bathroom #2. The facility does not have a swimming pool or large body of water. LPA did not observe a shaded seating area for the residents. Passageways and exits are free of obstruction.